The human immunodeficiency virus is a non-oncogenic human retrovirus that belonging to the lentivirus group type III. Acquired Immunodeficiency Syndrome (AIDS) is a complex of symptoms and infections caused by the HIV virus as it affects the immune system. Oral lesions have been stated to be early clinical features of HIV infection.
This article summaries the oral manifestations in the HIV patients because Dentists are possibly being the first health care provider to recognise and diagnose such lesions accurately.
AIDS is a complex of symptoms and infections caused by the HIV virus as it affects the immune system.
KAPOSI SARCOMA
It most common malignancy encountered in HIV/AIDS patients. Kaposi's sarcoma-associated herpes virus (KSHV)/Human Herpes Virus-8 (HHV-8) is the causative agent of the endothelial cell-derived tumour Kaposi's sarcoma.
The lesions are characterised by red‐ dish, bluish or purple, single or multiple macules or nodules. They are generally seen on the palate or gingivae and may ulcerate; gingival involvement may lead to underlying bone destruction and tooth mobility hence considered pathognomonic of HIV infections.
CHRONIC PERIODONTITIS
It is characterized by the severe destruction of the periodontal tissues characterized by rapid pocket formation and attachment loss with an increased rate of attachment loss. The radiograph suggests loss of alveolar bone. The risk factors for periodontitis in HIV positive patients include age, smoking pack-years and high viral load.
ORAL ULCERS
About 50% of AIDS patients present with oral ulcerations during the course of their disease. Recurrent aphthous ulcers (RAU) are of two types i.e. Minor aphthous Ulcers (MiAU) and Major Aphthous ulcers (MjAU).
MiAU: It occurs in non- keratinized mucosa and their frequency in AIDS patients is not any different from that in general population. These ulcers are shallow in appearance, about 2-5mm in diameter, are commonly covered with a whitish pseudomembrane and surrounded by an erythematous halo.
MjAU: Commonly seen in AIDS patients with severe immunodepression. These larger ulcers develop generally on the lateral border of the tongue, soft palate, floor of the mouth, buccal mucosa and oropharynx. They are crater-like in appearance with elevated borders and covered with a white-yellowish measuring over 1cm in diameter.
HERPES VIRUS INFECTIONS
Presence of Herpes zoster might indicate a poor prognosis of HIV infection. This can be an early complication of AIDS, where it is five times more common than HIV-negative Infection persons, and potentially fatal. Varicella-zoster may present with dental pain, preceding oral and unilateral vesicles on an erythematous base then appear in clusters, along the course of the nerve and giving the characteristic clinical picture of single dermatome involvement.
Dental surgeons serve as the first healthcare professionals to observe oral manifestations of HIV, making them crucial in the early detection of the virus. Many patients may be unaware of their HIV status, and the presence of specific oral lesions can be key indicators of the infection. Awareness of these lesions is vital not only for dental professionals but also for the general public. Understanding the various types of oral manifestations associated with HIV can facilitate earlier diagnosis and treatment. Conditions such as oral candidiasis, hairy leukoplakia, and Kaposi's sarcoma may present in the oral cavity before other symptoms of HIV or AIDS appear, making dental examinations an important opportunity for intervention. Educating both healthcare providers and the public about the risks and signs of HIV is essential for improving health outcomes. Increased awareness can lead to timely testing and management, ultimately contributing to better patient care. By fostering an understanding of the implications of oral lesions associated with HIV, we can enhance the overall approach to prevention, diagnosis, and treatment of the virus.Dr. Upma Tomar BDS, MDS (Senior Development Editor: Jaypee Publications)
ORAL HAIRY LEUKOPLAKIA (OHL)
This lesion usually presents as asymptomatic, white, vertical, corrugated, hair-like projections on the lateral borders of the tongue (bilaterally or unilaterally). It may spread to the dorsum of the tongue and on the ventral aspect to the floor of the mouth and occasionally on the adjacent buccal mucosa, and these areas are smooth and velvety not hair-like. Unlike candidiasis the lesion cannot be wiped off the mucosal surface.
ORAL CANDIDIASIS
Most common intraoral opportunistic fungal infection strongly associated with HIV infection. It has been reported that oral/oesophageal candidiasis, in HIV infected patients. The four clinical patterns seen are:
Pseudomembranous Candidiasis- The clinical sign appears as white to yellowish white plaques which can be easily scraped off, exposing red areas.
Erythematous Candidiasis- This lesion commonly seen as red lesions, which are commonly located on the dorsum of the tongue, palate, and buccal mucosa.
Hyperplastic Candidiasis - These lesions are characterized by white plaques which cannot be removed by scraping. Diagnosis can be confirmed by biopsy, which demonstrates the fungal hyphae in the keratinized layers of the epithelium
Angular Cheilitis - Erythema and/or fissuring and/or scaling of the angles of the mouth clinically characterize this lesion.
References
Vohram P., Jamatia K., Subhada B., Tiwari R.V.C., Althaf M.N., Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J. Fam. Med. Prim Care. 2019;8:3247–3252. doi: 10.4103/jfmpc.jfmpc_767_19.
Donoso F. Oral lesions associated with human immunodeficiency virus disease in adult patients, a clinical perspective. Rev. Chil. Infectol. 2016;33:27–35.
Berberi A., Noujeim Z. Epidemiology and Relationships between CD4+ Counts and Oral Lesions among 50 Patients Infected with Human Immunodeciency Virus. J. Int. Oral Health. 2015;7:18.
Agbelusi G.A., Eweka O.M., Ùmeizudikea K.A., Okoh M. Oral Manifestations of HIV. Curr. Perspect. HIV Infect. 2013:209–242. doi: 10.5772/52941.
Hopcraft M.S., Tan C. Xerostomia: An update for clinicians. Aust. Dent. J. 2010;55:238–244. doi: 10.1111/j.1834-7819.2010.01229.x.