Viruses and oral diseases in HIV‐infected individuals on long‐term antiretroviral therapy: What are the risks and what are the mechanisms?

Abstract

As a result of the extension of life span produced by increasing access to combined antiretroviral therapy, people living with HIV/AIDS (PLWH) face new challenges from comorbidities. Although advances in medical care for HIV infection have dramatically reduced opportunistic infections and AIDS‐defining cancers, some non‐AIDS‐defining cancers (NADC) and specific oral diseases such as periodontitis and salivary gland disease are now more prevalent. Cancer prevention is, therefore, a priority issue in care of PLWH, stressing both restoration of immune function and reduction of non‐HIV cancer risk factors (tobacco in all its forms; areca nut; heavy alcohol consumption; diets lacking antioxidant vitamins and minerals; and oncogenic virus infections) through specific interventions, especially tobacco and areca nut cessation and alcohol moderation. Detection of oral high‐risk human papillomaviruses (HR‐HPV) and the universal preventive HPV vaccination among PLWH should be promoted to reduce the malignancy burden, along with routine oral examinations which remain the cheapest, most reliable, most reproducible, and non‐invasive tool to identify suspicious lesions. Also, considerations of oral inflammation and periodontal health are important to replication and gene expression of viruses in the mouth. Considering that a key risk factor for this scenario is the presence of oncogenic virus infection such as several members of the human herpesvirus and human papillomavirus families, here we analyze the variables involved in the seeming increase in comorbidities in PLWH.

Stage II and stage III periodontitis clinical burdens of HIV-1 undergoing antiretroviral therapy

“…Thus, interventions targeting both inflammation and the microbiome, particularly in the oral cavity, may be necessary to reduce chronic immune dysregulation in patients with HIV. Recently, the increase in the prevalence of HPV-related oral conditions has been attributed to the immune reconstitution status [ 44 ] or age-related immune insufficiency, rather than as direct consequence of using antiretroviral therapy [ 45 ].…”

HIV Infection and Oral Manifestations: An Update

“…The OWs caused by HPV are among the most prevalent lesions of PLWH with a reported prevalence of about 0.5-6.9%, and HPV can be classified into subtypes according to its oncogenic level, and in the oral cavity, subtypes 6 and 11 are the most prevalent; about 90%, in OWs such as condylomas and laryngeal papillomas, have lower oncogenic potential. HPV is highly sexually transmitted; being frequent in the genital and anal region, its incidence in the oral mucosa is due to acts of self-inoculation or oral sexual contact [112][113][114][136][137][138][139].…”

“…Topically, a cream called imiquimod (50 mg/g) serves as an immunomodulatory cream that must be applied to the wart site once a day, three times a week for up to 28 days. Systemically, the use of antivirals such as cidofovir (5 mg/kg) is recommended, which should be administered once a week for up to 14 days [112][113][114][136][137][138][139].…”

Human papillomavirus and Epstein‐Barr virus co‐infection in oral and oropharyngeal squamous cell carcinomas: A systematic review and meta‐analysis

“…Persistent HPV infection in the oral cavity is a risk factor for developing both OSCC and OPSCC (Carpén et al., 2020a; Jamieson et al., 2020; Kim, 2016; Pérot et al., 2020). HPVs are sexually transmitted and social factors such as an early initiation of sexual activity, a high number of sex partners and the practice of unprotected oral sex are widely considered to be the drivers of the OPSCC epidemic (Hübbers & Akgül, 2015; Johnson, Anaya‐Saavedra, et al., 2020). Indeed, immunocompromised individuals, such as HIV‐infected individuals, are at greater risk (Hübbers & Akgül, 2015).…”