Oral Manifestations Of HIV and

its management
Opportunistic diseases--manifestations of immune deficiency or derangement. Not caused directly by HIV. The same lesions occur in association with other immune deficiency disorders.

HIV-related Oral Lesions

Infections
Fungal, Viral, Bacterial Neoplasms Kaposis Sarcoma, Non-Hodgkins Lymphoma Other Non-specific or Aphthous-like Ulcers, Lichenoid or Drug Reactions, Salivary Gland Disease

Oral Candidiasis
Pseudomembranous Erythematous Hyperplastic

Accompanying angular cheilitis

Pseudomembranous
Candidiasis
Appearance: white curd-like material that wipes off revealing an underlying erythematous mucosa
Clinical Diagnosis: generally made on the basis of appearance

Erythematous Candidiasis
Appearance: mucosal erythema and/or patchy-depapillation of the dorsal tongue
Definitive diagnosis requires:
Identification of fungal hyphae in the lesion Response of the lesion(s) to antifungal therapy

Hyperplastic Candidiasis
Appearance: as a leukoplakia (a white lesion that does not rub off)
Definitive diagnosis requires:
Identification of fungal hyphae in the lesion Response of the lesion(s) to antifungal therapy If unresponsive to antifungal therapy, biopsy must be considered

Angular Cheilitis
Appearance: erythema and/or fissuring at the corners of the mouth Frequently accompanies intraoral candidiasis

Treatment Of Oral Candidiasis

Topical Antifungal Therapy cotrimazole Systemic Antifungal Therapy fluconazole , ketoconazole

Hairy Leukoplakia
Appearance: white corrugated lesion on the lateral border of the tongue Clinical Diagnosis:
known seropositive patients patients with unknown HIV status definitive diagnosis requires identification of Epstein-Barr virus infected epithelial cells

Hairy Leukoplakia
Treatment and Management:
Generally does not require treatment Antiviral treatment and topical podophyllum resin have been used to treat --the result is temporary May wax and wane without treatment

Oral Ulcers
Herpes simplex infection
Varicella zoster infection (Shingles)

Histoplasmosis

Lymphoma
Necrotizing ulcerative gingivitis (NUG) Necrotizing ulcerative periodontitis (NUP) Necrotizing stomatitis (NS)

Cytomegalovirus infection Aphthous ulcers

Herpes Simplex Infection

Atypical herpes simplex ulceration is a frequent cause of mucosal ulceration Diagnosis may be confirmed using mucosal smear, viral isolation (culture) or biopsy Ulcers generally respond to systemic anti-viral treatment systemic acyclovir 30/mg/kg/day

Low Incidence Infections

Viral Varicella-Zoster Cytomegalovirus Fungal Histoplasmosis Bacterial Tuberculosis Syphilis

Major Aphthous-like Ulcers

Appearance: persistent, nonspecific ulcers

Biopsy and histologic examination may be necessary to exclude other causes

Systemic and topical corticosteroid therapy have been successful management Topical tetracycline application and systemic thalidomide have also be used

Non-Hodgkins Lymphoma
Appearance: necrotic, ulcerated or nonulcerated masses, when occurring in the oral cavity
Diagnosis: biopsy and histologic examination

Managed by chemotherapy and radiation therapy

Necrotizing Ulcerative Periodontal Disease

Characterized by painful gingival ulceration and may result in loss of alveolar bone Management:
antibiotic therapy debridement of necrotic tissue meticulous home care

Lesions Caused By Human

Papilloma Virus (HPV)
Appearance: exophytic, papillary, oral mucosal lesions
Several different types of HPV have been reported to cause lesions May be multiple

Often difficult to treat due to a high risk of recurrence

Local excision of wart should be carried out

Pigmented And Erythematous

Lesions
Kaposis sarcoma Mucosal melanin pigmentation Linear gingival erythema

Kaposis Sarcoma
Appearance: Oral lesions appear as reddish purple, raised or flat Size ranges from small to extensive Behavior is unpredictable Definitive diagnosis: biopsy and histologic examination

No curative therapy--radiation treatment, chemotherapy and sclerosing agents have been, used to control oral lesions

Mucosal Melanin Pigmentation

Single and multiple oral mucosal melanotic macules have been report to occur in HIV infected individuals
Significance is not known Some have been associated with zidovudine therapy Treatment is not indicated

Linear Gingival Erythema

Appearance: a distinct band of erythema of the gingival margin Erythema does not respond to removal of local factors
Cause is not known Management include debridement, oral hygiene maintenance and antimicrobial therapy

Salivary Gland Disease

Bilateral parotid gland enlargement occurs in HIV infected individuals Histology has been described as resembling autoimmune salivary gland disease with cystic changes Use of salivary stimulants such as sugarless gum and salivary substitute may provide relief Oral prednisolone and antiretroviral therapy should be given