Urban legends series: oral manifestations of HIV infection

Abstract

Human immunodeficiency virus-related oral lesions (HIV-OLs), such as oral candidiasis (OC) and oral hairy leukoplakia (OHL), have been recognized as indicators of immune suppression since the beginning of the global HIV epidemic. The diagnosis and management of HIV disease and spectrum of opportunistic infection has changed over the past 30 years as our understanding of the infection has evolved. We investigated the following controversial topics: (i) Are oral manifestations of HIV still relevant after the introduction of highly active antiretroviral therapy (HAART)? (ii) Can we nowadays still diagnose HIV infection through oral lesions? (iii) Is the actual classification of oral manifestations of HIV adequate or does it need to be reviewed and updated? (iv) Is there any novelty in the treatment of oral manifestations of HIV infection? Results from extensive literature review suggested the following: (i) While HAART has resulted in significant reductions in HIV-OLs, many are still seen in patients with HIV infection, with OC remaining the most common lesion. While the relationship between oral warts and the immune reconstitution inflammatory syndrome is less clear, the malignant potential of oral human papillomavirus infection is gaining increasing attention. (ii) Effective antiretroviral therapy has transformed HIV from a fatal illness to a chronic manageable condition and as a result expanded screening policies for HIV are being advocated both in developed and in developing countries. Affordable, reliable, and easy-to-use diagnostic techniques have been recently introduced likely restricting the importance of HIV-OLs in diagnosis. (iii) The 1993 EC-Clearinghouse classification of HIV-OLs is still globally used despite controversy on the relevance of periodontal diseases today. HIV-OL case definitions were updated in 2009 to facilitate the accuracy of HIV-OL diagnoses by non-dental healthcare workers in large-scale epidemiologic studies and clinical trials. (iv) Research over the last 6 years on novel modalities for the treatment of HIV-OLs has been reported for OC and OHL.

Investigation and Analysis on Pathogen Distribution of HIV/AIDS Patients with Opportunistic Infection

“…Candida albicans is the dominating bacteria in oropharyngeal engraftment of region's HIV/ AIDS patients, which is consistent with what Balkhair, et al reported [8]. That is, there is a close relationship between engraftment of immune status and patients' immunity condition [9]- [11]. PSM mostly distributes in the circulatory system and joint, parts of it in the respiratory tract, enteron.…”

Major recurrent aphthous stomatitis in mother and son with HIV/AIDS infection – Case report

“…This classification considers that the incidence of major and herpetiformis types are increased in patients with HIV infection [7]. For pediatric patients with HIV infection this classification is modified and recurrent aphthous stomatitis is in the group 1 (lesions commonly associated with pediatric HIV infection) [8].…”

Oral Hairy Leukoplakia

“…They have been accepted as markers of immunosuppression (Miziara and Weber 2006 ;Reginald and Sivapathasundharam 2010 ;Patton et al, 2013 ), contributing for the early identifi cation of HIV infection or AIDS (Dias et al, 2012 ). In addition, OHL and OC can be a sign to warn dentists on the decreasing immunological condition of HIVinfected patients (Moura et al, 2006 ;Sontakke et al, 2011 ;Bodhade et al, 2011 ).…”

“…Moura et al ( 2010 ) observed that the treatment with podophyllin with acyclovir cream was more effective in the clinical healing rate for OHL than podophyllin and podophyllin with penciclovir cream, and no recurrent OHL was observed in this fi rst treatment. Additional studies have been conducted on the treatment for OHL with antiviral agents in topical creams (Patton et al, 2013 ).…”