The question I most commonly get asked by oral health providers is...
Do I pre-medicate patients based on a high viral load and low CD4 count?
There is no supporting data to support the need for routine antibiotic coverage pre or post dental treatment based on the CD4 or viral load. Antibiotic use in the HIV positive patient may predispose patients to adverse drug reactions, superinfection, and drug-resistant microorganisms, so antibiotics should be used judiciously, not routinely. Indications for all dental procedures are the same for HIV-positive patients as for any other patient. For extractions and other surgical procedures, preoperative scaling and use of a chlorhexidine rinse may be performed to help reduce the risk of postoperative complications. Other conditions that may require modification of dental treatment are reduced platelet count <60,000 cells/mL, which may affect clotting, antibiotic prophylaxis to prevent bacterial endocarditis, or white-blood-cell neutrophil counts <500 cells/mL, which may require antibiotic prophylaxis. When in question, also consult with the patient’s physician.
Another great resource is the American Dental Association's Oral Health Topics: HIV page.
For additional questions or dental consultation and training contact Martia West at the South Florida Southeast AETC.
Mosca NG, Rose Hathorn A. HIV-Positive Patients: Dental Management Considerations. Dental Clinics of North America 2006;50(4):635-57.