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ORAL MANIFESTATION OF HIV
INFECTIONS
What is the importance ?
1. Oral cavity can be easily examined
2. Common
3. Early recognition diagnosis and treatment
may reduce morbidity
4. Early diagnostic indicator
5. May change the staging
6. Predictor of progression of HIV done
Fungal lesions
Viral
Bacterial
Neoplastic
Minor oral ulcers
FUNGAL LESIONS
Oral Candidiasis
• Candida albicani
• Candida glabrata and C.tropicalis
• Common oral manifestation of acute stage of
HIV infection
• Occur with falling CD4 + T cell count in middle
and late stages of HIV
• Other predisposing factors, are infancy, old age,
antibiotic therapy, steroids and other
immunosuppressive drugs, xerostamia,
anaemia, endocrine disorders, primary and
acquired immunodeficiency.
CLINICAL FEATURES
• Burning mouth, problems eating spicy
food and changes in taste.
• Clinical appearance varies
• Common are pseudomembranous and
erythematous candidiasis
HISTOPLASTOMIES
• Appear as oral ulcers
• Diagnosis requires biopsy
Cryptococcus neoformans
• Ulcerated mass in the hard palate. Biopsy
of palatal ulcer is diagnostic.
VIRAL LESIONS
• Painful persistent large intraoral
ulcers
• Buccal/ labial mucosa 27%, tongue
25%, gingiva – 18%
Recurrent herpes simplex (H.Labialis,
cold sores)
• Develop on the lips
• Intraorally in the keratinised mucosa of palate and
gingiva.
• Begins as a burning sensation followed by small
coalseing vesicles.
• Ulcer surrounded by erythematous halo
• No scan formation
• Importance – Patients with advanced HIV disease
may present several recurrence a year especially
characterized by large confluent and extremely
painful ulceration.
HERPES ZOSTER
• Painful oral lesion or tooth ache
• Usually unilateral
• Follow the distribution of maxillary and /or
mandibular branches of trigeminal nerve.
Human Papilloma
• Oral wart
• Papilloma
CYTOMEGALOVIRUS
• Confused with aphthous ulcers, necrotizing
ulcerative periodontitis and lymphoma
• Aphthous ulcer
• CMV Diagnosis by biopsy and
immunohistochemistry
HAIRY LEUKOPLAKIA
• Non movable corrugated or hairy white
lesion on the lateral margins of tongue.
• Occurs in 20% of person with asymptomatic
HIV infection
• Becomes more common as the CD4+T cell
count falls
• Non HIV patients who are affected are
recipients of bone marrow, cardiac and renal
transplants
BACTERIAL INFECTION
Periodontal Disease
Necrotising ulcerative periodontitis
- Rapid and severe course
Linear gingival erythema – relative mild form
MYCOBACTERIUM AVIUM
INTRACELLULARE
• Palatal and gingival granulomatous masses
• Diagnosed by AFB staining of biopsy
specimens
NEOPLASTIC LESION
• This may occur intraorally either alone or
association with skin and disseminated
lesion.
• Common in men
• First manifestation of late stage of HIV
DIFFERENTIAL DIAGNOSIS
• Vascular lesion – haematoma,
haemangioma
• Pyogenic granuloma
• Bacillary angiomatosis
• Oral melanotic macules
No bleeding associated with a biopsy of
oral KS aspiration prior to biopsy may be
useful to rule out haemangioma. Sudden
appearance is characteristic.
LYMPHOMA
• Firm painless swelling that may be
ulcerated
• Occur anywhere in the oral cavity
• Soft tissue involvement
• Bony involvement
DIFFERENTIAL DIAGNOSIS
• Confusion with major aphthous ulcers and
rarely pericoronitis associated with an
erupting third molar
• Diagnosis made by histologic examination
of biopsy specimen.
OTHER ORAL LESIONS
• Recurrent Aphthous ulcers (RAU)
• Cause unknown – Stress and
unidentified infectious agents
• Minor RAU – Well circumscribed with
erythematous margin.
• Solitary lesion of 0.5-1cm
• Herpetiform type RAU- Clusters of
small ulcers
Major RAU –
Extremely large
necrotic ulcer 2-4cm
• Idiopathic thrombocytopenic purpura may
first manifest as oral lesion in HIV
infected patients
• Xerostomia
Oral manifestation in children with
AIDS
• Children infected with HIV develop severe
immunosuppression very early
• Earlier than adults
• Fungal infections are more
DIAGNOSIS
• Detection of antiviral protein
• CD4+ T Cell count – oral abnormalities
result from changes in the immune status
of HIV carrier – Due to reduction in the
number of CD4 + T cells and / or
modification of CD4 / CD8 ratio.
• Increased T8 cells in germinal centres.
TREATMENT
• Most of the opportunistic infections are
incurable. But by aggressively treating the
acute disease, the infection can be
controlled and suffering of patient
decreased.
• Cryptococcus –
Amphotericin B 0.50.8mg/kg/d iv
• Bacterial-
Ampicillin
TrimethoprimChloramphenicol
Ceftriaxone
• Viral
-
Ganciclovir IV
Sulphamethoxazole
PREVENTION
Teach
ABC of AIDS prevention
Abstrain
Be faithful
Use Condom
Dental Surgeons – High risk category - use
gloves, Goggles, Facemask.
Every patient is HIV positive until other wise
proved.