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HIV/ AIDS
Guadalupe Compean
Diana Martinez
Thu Ton
Etiology
• HIV (Human immunodeficiency virus) is a retrovirus that
causes AIDS. It is transmitted through interaction with an
infected individual’s blood, semen, cervical secretions,
cerebrospinal fluid, or synovial fluid. It infects T-helper
cells of the immune system and results in infection with a
long incubation period averaging 10 years.
• An increase in viral load and severe decrease in CD4+ T
cells is the progression to AIDS in which the immune
system breaks down. People who have AIDS are likely to
develop serious infections and cancers. These infections,
called “opportunistic infections,” are not usually seen in
people whose immune system is intact.
Occurrence & Population
• More than 1.1 million people in the United States are
living with HIV infection, and almost 1 in 6 people are
unaware of their infection.
Modes of Transmission
• Infected through the blood
-Blood transfusions
-Sharing needles and accidental needle sticks
• Perinatal
-Mother to child: travels through placenta
-Breast milk
• Sexual contact
-Semen or vaginal secretions
-Multiple partners
Treatment
• Tests and diagnosis
1.
2.
3.
CD4 count
Viral load
Drug resistance
• There is no cure for this disease but a combination of
different drugs can control the virus. Each of the antiHIV drugs blocks the virus in different ways to avoid
creating strains of HIV that are resistant to single
drugs. The highly active antiretroviral therapy
(HAART) will help reduce the viral load, improve
their lifestyle, restore or preserve immune system
function, and reduce morbidity and mortality rate.
Medications
• Non-nucleoside reverse transcriptase inhibitors
(NNRTIs): ex. Nevirapine, Delavirdine mesylate
• Nucleoside reverse transcriptase inhibitors
(NRTIs): ex. Abacavir, Zidovudine, Didanosine,
Lamivudine, Combivir
• Protease inhibitors (PIs): ex. Indinavir, Ritonavir,
Saquinavir, Nelfinavir mesylate
• Entry or fusion inhibitors: ex. Enfuvirtude
• Integrase inhibitors: ex. Raltegravir
Indications & Contraindications
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Indications for HIV/AIDS patient:
Antimicrobial mouth rinse should be recommended
Fluoride treatment should also be considered
Prevent opportunistic infections
• Contraindications for HIV/AIDS patient:
- Patients with blood sugar levels greater than 200 mg/dL can cause
a poor response and lead to infection after treatment.
- These patients are at high risk for developing oral infection after
oral surgery or periodontal debridement and if there neutrophil
count is less than 500 cell/mm3 they will need pre-medication.
- Side effects of medications could lead to increased bleeding and
infection.
Oral Manifestations
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Linear gingival erythema
Necrotizing ulcerative gingivitis & periodontitis (NUG and NUP)
Hairy leukoplakia
Candidiasis
Herpes zoster infection
Herpes labialis (intraoral herpes simplex virus infection)
Human papilloma virus infection
Kaposi’s sarcoma
Angular chelitis
Xerostomia
Apthous ulcers
Salivary gland disease
Oral Manifestations cont.
• Pain and oral implications may be caused by disease
or from adverse drug effects of HAART.
• Adverse effects of the primary antiretroviral
medication:
• Zidovudine will cause nausea and vomiting and can lead to
dental caries and dental erosion.
• Topical medications that contain sugar can cause the
development of caries.
• It is our job to inform our patient about the
importance of personal oral hygiene care, frequent
dental cleanings, and fluoride therapy to help lower
viral load and prevent oral infections.
Periodontal Management
• The use of salivary supplements, daily fluoride
treatments, and frequent dental visits is important to help
control HIV/AIDS impact on the oral health.
• The combination of dental procedures and antiviral drug
therapy will help reduce opportunistic infections from
occurring.
Pre-Med
• There is no difference in treatment between
patients with HIV/AIDS and those who do not
have HIV/AIDs.
• No pre-medication is necessary unless the
patient’s neutrophil count is less than 500
cells/mm3 and if they are severely neutropenic.
Dental Considerations
• Patient positioning:
o Recommended to use semi-supine chair position.
• Appointment length:
o The duration of the appointment will depend on the
dental treatment that the patient will receive and the
same considerations are used with patients that don’t
have HIV/AIDS.
Dental Considerations
• Ultrasonic use:
o It is safe to use a high-speed ultrasonic instruments for
periodontal management with HIV-positive patients.
However, dental professionals should prevent contact with
splashes and spatter with patient’s position properly and
make appropriate use of barriers such as face-shields,
surgical masks, rubber dams, and high volume evacuators.
• Recall Intervals:
o Patients with HIV/AIDS should have recall visits to the
dental office about every three months. This will help find
infections and conditions early in order for patients to
receive treatment and prevent a problem.
1.Select from the following the route that is NOT involved
in HIV transmission:
A. Exposure to contaminated blood, blood products, or
blood-contaminated body fluids
B. Infected mother to unborn child
C. Intimate sexual contact involving the exchange of
semen or vaginal secretions
D. Casual contact with a recently seroconverted HIVpositive individual
2.HIV causes significant health changes in infected
individuals by:
A. Attacking the T4-lymphocytes, thus causing an
increase in opportunistic infections
B. Attacking plasma cells, thus interrupting the
production of antibodies and reducing the host’s
resistance to disease
C. Increasing capillary permeability, thus causing
redness, itching, and swelling in affected areas
D. Attacking plasma cells, thus altering antibodies so
that they do not recognize the person’s own tissues as
friendly
3.Which cell in the immune system is changed, replicated
and destroyed in HIV/AIDS:
A. T-4 (T-helper lymphocytes)
B. T-8 (T-suppressor lymphocytes)
C. HTLV-111
D. Retrovirus
QUESTIONS??
References
Centers for Disease Control and Prevention. (2013). HIV/AIDS.
Retrieved from
http://www.cdc.gov/hiv/statistics/surveillance/incidence/
Ibsen, O. A.C., Phelan, J. A. (2008). Oral pathology for the dental
hygienist. United States: Elsevier-Health Sciences Division.
Mayo Clinic. (2012). HIV/AIDS. Retrieved from
http://www.mayoclinic.com/health/hiv-aids/DS00005
Wilkins, E. M., (2012). Clinical practice of the dental hygienist.
United States: Lippincott Williams & Wilkins.
Sonis, S. T., Fazio, R. C., Fang, L. S. T., (2002). Oral medicine secrets.
United States: Hanley & Belfus.