ORAL INFECTIONS AND OTHER MANIFESTATIONS OF HIV DISEASE

doi:10.1016/S0891-5520(05)70114-8

Infectious Disease Clinics of North America

Volume 13, Issue 4, 1 December 1999, Pages 879-900

https://doi.org/10.1016/S0891-5520(05)70114-8 Get rights and content

Between 20% and 50% of HIV-infected patients develop oral lesions during their disease course.5, 81 Oral lesions may give clues to primary acute HIV infection128, 129 and suggest HIV disease progression, as many oral opportunistic conditions have been associated with immune suppression.6, 31, 32, 65, 118

The Centers for Disease Control and Prevention (CDC) include the two most common oral lesions, oral hairy leukoplakia and oral candidiasis, in their 1993 HIV disease classification system⁸ as clinical markers of symptomatic HIV infection (clinical category B). Other oral mucosal conditions, such as oral Kaposi's sarcoma, cytomegalovirus (CMV) ulcers, and herpes simplex virus ulcers persisting beyond 1 month, are AIDS-defining oral conditions.⁸ Two groups in the United States and Europe convened in the early 1990s to establish consensus on the classification of oral manifestations of HIV infection and their diagnosis, based on presumptive and definitive criteria.17, 37 Oral manifestations generally fall within five etiological categories: fungal, bacterial, viral, neoplastic, and miscellaneous lesions.

Section snippets

Candidiasis

Oral candidiasis is one of the most common oral manifestations of HIV/AIDS, affecting approximately one third of HIV-positive individuals and more than 90% of patients with AIDS at some time in their disease course.⁷⁹ It may be the initial sign of HIV infection,⁷¹ and is a harbinger of immunologic decline¹¹⁰ and progression to AIDS.⁶⁰ Oral candidiasis may develop as a result of imbalance of endogenous oral flora in other compromised conditions, such as diabetes, hematologic disorders,

Linear Gingival Erythema

Linear gingival erythema (LGE; formerly called HIV-associated gingivitis or HIV-G) appears as a distinct fiery red band along the margin of the gingiva at least 2 mm wide, without ulceration¹⁷ (Fig. 2). Prevalence is relatively low, and we have reported a rate of 4% in our HIV population.⁹¹ Although gingival erythema is usually associated with plaque accumulation and poor oral hygiene, this atypical gingivitis often exists where there is little plaque, and does not improve significantly with

Oral Hairy Leukoplakia

Oral hairy leukoplakia (OHL) is one of the two most common oral manifestations of HIV.⁴² It was first identified in homosexual men with AIDS in San Francisco as a white thickening of the lateral border of the tongue, with vertical “hairy” projections and corrugations (Fig. 4).³⁹ OHL is predominantly found on the lateral border of the tongue, but may extend to the tongue's ventral and dorsal surfaces, where it is usually flat and plaque-like. It has been found rarely on other oral mucosal sites,

Kaposi's Sarcoma

Oral Kaposi's sarcoma (KS) is the most common neoplasm found in AIDS patients, and is associated with advanced immune suppression.²³ Oral KS prevalence is reported to be 1.7% to 20%, and is declining in prevalence, with lesions occurring most often among men who have sex with men.23, 91, 102 A potential etiologic infective agent for KS, called human herpesvirus type 8 (HHV8) or Kaposi's sarcoma-associated herpesvirus (KSHV), was identified in 1994.¹⁰ HHV8 has been isolated from oral KS.¹⁶ This

Recurrent Aphthous Ulcers

In addition to the common minor or herpetiform varieties of recurrent aphthous ulcers (RAU), approximately 1.1% to 3.1% of HIV-infected individuals may develop the otherwise uncommon, severe major aphthous type.84, 92 Major RAU have been temporally associated with symptomatic HIV disease and severe immune suppression (both CD4 lymphopenia and neutropenia).⁷⁶ These severely painful crateriform ulcers measure 10 to 30 mm in diameter, last for weeks to months if untreated, and heal with scarring

SUMMARY

Oral lesions are important in the clinical spectrum of HIV/AIDS, arousing suspicion of acute seroconversion illness (aphthous ulceration and candidiasis),128, 129 suggesting HIV infection in the undiagnosed individual (candidiasis, hairy leukoplakia, Kaposi's sarcoma, necrotizing ulcerative gingivitis),⁶⁹ indicating clinical disease progression and predicting development of AIDS (candidiasis, hairy leukoplakia),60, 81 and marking immune suppression in HIV-infected individuals (candidiasis,

References (138)

M.D. Begg et al.
Oral lesions as markers of severe immunosuppression in HIV-infected homosexual men and injection drug users
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(1996)
J. Blomgren et al.
Oral hairy leukoplakia in a patient with multiple myeloma
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(1996)
M.M. Chidzonga
Noma (cancrum oris) in human immunodeficiency virus/acquired immune deficiency syndrome patients: Report of eight cases
J Oral Maxillofac Surg
(1996)
Di AlbertiL. et al.
Kaposi's sarcoma herpesvirus in oral Kaposi's sarcoma
Eur J Cancer Oral Oncol
(1996)
J.B. Epstein et al.
HIV infection: Clinical features and treatment of thirty-three homosexual men with Kaposi's sarcoma
Oral Surg Oral Med Oral Pathol
(1991)
G. Ficarra et al.
Kaposi's sarcoma of the oral cavity: A study of 134 patients with a review of the pathogenesis, epidemiology, clinical aspects, and treatment
Oral Surg Oral Med Oral Pathol
(1988)
C.M. Flaitz et al.
Herpesviridae-associated persistent mucocutaneous ulcers in acquired immunodeficiency syndrome: A clinicopathologic study
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(1996)
M. Glick et al.
Oral manifestations associated with HIV-related disease as markers for immune suppression and AIDS
Oral Surg Oral Med Oral Pathol
(1994)
J. Goldstein et al.
Radiation therapy as a treatment for benign lymphoepithelial parotid cysts in patients infected with human immunodeficiency virus-1
Int J Radiat Oncol Biol Phys
(1992)
G. Gowdey et al.
Treatment of HIV-related hairy leukoplakia with podophyllum resin 25% solution
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(1995)

M.S. Greenberg et al.

Relationship of oral disease to the presence of cytomegalovirus DNA in the saliva of AIDS patients

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

(1995)

J.S. Greenspan et al.

Oral manifestations of HIV infection: Definitions, diagnostic criteria, and principles of therapy

Oral Surg Oral Med Oral Pathol

(1992)

D. Greenspan et al.

Oral “hairy” leucoplakia in male homosexuals: Evidence of association with both papillomavirus and herpes-group virus

Lancet

(1984)

J.S. Greenspan et al.

Oral hairy leukoplakia: Diagnosis and management

Oral Surg Oral Med Oral Pathol

(1989)

GrootR.H. et al.

Oral manifestations of non-Hodgkin's lymphoma in HIV-infected patients

Int J Oral Maxillofac Surg

(1990)

G.S. Heinic et al.

Oral CMV lesions and the HIV infected: Early recognition can help prevent morbidity

JADA

(1993)

J.S. Herbst et al.

Comparison of the efficacy of surgery and acyclovir therapy in oral hairy leukoplakia

J Am Acad Dermatol

(1989)

K.D. Hunter et al.

Fluconazole-resistant Candida species in the oral flora of fluconazole-exposed HIV-positive patients

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

(1998)

S. Itescu et al.

Diffuse infiltrative lymphocytosis syndrome: A disorder occurring in human immunodeficiency virus-1 infection that may present as a sicca syndrome

Rheum Dis Clin North Am

(1992)

A.C. Jones et al.

Cytomegalovirus infections of the oral cavity: A report of six cases and review of the literature

Oral Surg Oral Med Oral Pathol

(1993)

A. Kolokotronis et al.

Immunologic status in patients infected with HIV with oral candidiasis and hairy leukoplakia

Oral Surg Oral Med Oral Pathol

(1994)

F. Lozada-Nur et al.

Retrospective findings of the clinical benefits of podophyllum resin 25% sol on hairy leukoplakia: Clinical results in nine patients

Oral Surg Oral Med Oral Pathol

(1992)

Lozada-NurF. et al.

Intraoral non-Hodgkin's lymphoma in seven patients with acquired immunodeficiency syndrome

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

(1996)

F. Lozada-Nur et al.

Oral hairy leukoplakia in nonimmunosuppressed patients: Report of four cases

Oral Surg Oral Med Oral Pathol

(1994)

F.M. Lucatorto et al.

Treatment of oral Kaposi's sarcoma with a sclerosing agent in AIDS patients: A preliminary study

Oral Surg Oral Med Oral Pathol

(1993)

L.A. MacPhail et al.

Recurrent aphthous ulcers in association with HIV infection: Description of ulcer types and analysis of T-lymphocyte subsets

Oral Surg Oral Med Oral Pathol

(1991)

L. Mandel et al.

Parotid gland swelling in HIV diffuse infiltrative CD8 lymphocytosis syndrome

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

(1998)

S.L. Melnick et al.

Oral mucosal lesions: Association with the presence of antibodies to the human immunodeficiency virus

Oral Surg Oral Med Oral Pathol

(1989)

R.A. Monteil et al.

Histological and ultrastructural study of one case of oral bacillary angiomatosis in HIV disease and review of the literature

Eur J Cancer Oral Oncol

(1994)

B.C. Muzyka et al.

Major aphthous ulcers in patients with HIV disease

Oral Surg Oral Med Oral Pathol

(1994)

C.M. Nichols et al.

Treating Kaposi's lesions in the HIV-infected patient

JADA

(1993)

J.A. Phelan et al.

Major aphthous-like ulcers in patients with AIDS

Oral Surg Oral Med Oral Pathol

(1991)

J.A. Phelan et al.

Resolution of oral hairy leukoplakia during treatment with azidothymidine

Oral Surg Oral Med Oral Pathol

(1988)

P. Piedbois et al.

Radiotherapy in the management of epidemic Kaposi's sarcoma

Int J Radiat Oncol Biol Phys

(1994)

S. Piluso et al.

Cause of oral ulcers in HIV-infected patients: A study of 19 cases

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

(1996)

J.A. Regezi et al.

Herpes simplex and cytomegalovirus coinfected oral ulcers in HIV-positive patients

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

(1996)

K. Adler-Storthz et al.

Prevalence of Epstein-Barr virus and human papillomavirus in oral mucosa of HIV-infected patients

J Oral Pathol Med

(1992)

H. Albrecht et al.

Resolution of oral hairy leukoplakia during treatment with foscarnet

AIDS

(1994)

E.K. Bagdades et al.

Relationship between herpes simplex virus ulceration and CD4+ cell counts in patients with HIV infection

AIDS

(1992)

H.H. Balfour

Varicella zoster virus infections in immunocompromised hosts: A review of the natural history and management

Am J Med

(1988)

C.E. Barr et al.

HIV-associated oral lesions: Immunologic, virologic and salivary parameters

J Oral Pathol Med

(1992)

Centers for Disease Control

1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults

MMWR

(1992)

Centers for Disease Control and Prevention

1997 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus

MMWR

(1997)

Y. Chang et al.

Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi's sarcoma

Science

(1994)

B.B. Chappuis et al.

Identification of EBV-DNA in lymph nodes from patients with lymphadenopathy and lymphomas associated with AIDS

Virchows Arch B Cell Pathol

(1990)

D.A. Cooper et al.

Zidovudine in persons with asymptomatic HIV infection and CD4+ cell counts greater than 400 per cubic millimeter

N Engl J Med

(1993)

R.O. Darouiche

Oropharyngeal and esophageal candidiasis in immunocompromised patients: Treatment issues

Clin Infect Dis

(1998)

De SousaY.G. et al.

Localization of Epstein-Barr virus DNA in the epithelial cells of oral hairy leukoplakia by in situ hybridization on tissue sections

N Engl J Med

(1989)

Classification and diagnostic criteria for oral lesions in HIV infection

J Oral Pathol Med

(1993)

El-Sadr W, Oleske JM, Agins BD, et al: Evaluation and Management of Early HIV Infection: Clinical Practice Guideline....

Cited by (40)

Antifungal prescribing pattern and attitude towards the treatment of oral candidiasis among dentists in Jordan
2015, International Dental Journal
Aim: The aim of this study was to evaluate the attitude of Jordanian dentists towards the treatment of oral candidiasis and their current antifungal prescribing habits, shedding more light on the possible influence of their socio-professional factors on the pattern of prescribing and practice. Methods: A structured validated questionnaire was developed and tested; it was then emailed to a random sample of 600 Jordanian dental practitioners during the period of this cross-sectional survey. The questionnaire recorded practitioners’ personal details and their attitude and prescribing of antifungal therapy for oral candidiasis. Statistical significance was based on probability values of <0.05 and was measured using the chi-square and Fisher’s exact tests. Multiple logistic regression analysis was used to analyse the influence of respondents’ socio-professional factors on their attitude towards oral candidiasis. Results: Of the 423 questionnaires returned, only 330 were included. The attitude of respondents was significantly influenced by their experience [odds ratio (OR) = 0.14; P < 0.001] and workplace (OR = 4.70; P < 0.001). Nystatin was the most commonly prescribed antifungal agent (78.2%), followed by miconazole (62.4%), which was prescribed for topical use. Systemic antifungals were prescribed by 21.2% of respondents, with a significant (P < 0.05) association with the country in which their qualification was obtained. Conclusion: The attitude towards the treatment of oral candidiasis is much better among the least-experienced dentists working in private practice. Nystatin and miconazole are the most popular choices of antifungal agents among Jordanian dentists.
Effect of Leflunomide, Cidofovir and Ciprofloxacin on replication of BKPyV in a salivary gland in vitro culture system
2015, Antiviral Research
Citation Excerpt :
HIV-associated salivary gland disease (HIV-SGD) has been universally established as one of the most important AIDS-associated oral lesions. Oral lesions are important clinical indicators for HIV/AIDS, indicating clinical disease progression and predicting development of AIDS (Patton and van der Horst, 1999). In developing countries the incidence of HIV-SGD has been reported to be as high as 48% among HIV-1 infected patients (McArthur et al., 2000).
BK polyomavirus (BKPyV) is a known kidney tropic virus that has been detected at high levels in HIV-associated salivary gland disease (HIV-SGD), one of the most important AIDS associated oral lesions. BKPyV has been detected in HIV-SGD patient saliva and replicates in salivary gland cells in vitro. BKPyV antivirals are currently in wide use to guard against BKPyV mediated organ rejection in kidney transplant recipients. The goal of this study was to investigate the inhibitory effects of three such antiviral agents, Ciprofloxacin, Cidofovir, and Leflunomide in BKPyV infected salivary gland cells. Human salivary gland cells, and Vero cells, were infected with BKPyV, treated with antiviral drugs and assessed for BKPyV gene expression and viral replication for up to 5 days post infection. The kinetics of BKPyV replication were different in salivary gland cells compared to kidney cells. Ciprofloxacin and Cidofovir had minimal effect on metabolic activity and host cell DNA replication, however, cell toxicity was detected at the protein level with Leflunomide treatment. Ciprofloxacin decreased BKV T Ag and VP1 mRNA expression by at least 50% in both cell types, and decreased T Ag protein expression at days 3 and 4 post infection. A 2.5–4 log decrease in intracellular DNA replication and a 2–3 log decrease in progeny release were detected with Ciprofloxacin treatment. Cidofovir and Leflunomide also inhibited BKPyV gene expression and DNA replication. The three drugs diminished progeny release by 30–90% and 2– to 6-fold decreases in infectious virus were detected post drug treatment by fluorescence focus assay. Additionally, three clinical BKPyV isolates were assessed for their responses to these agents in vitro. Cidofovir and Leflunomide, but not Ciprofloxacin treatment resulted in statistically significant inhibition of BKPyV progeny release from salivary gland cells infected with HIVSGD BKPyV isolates. All three drugs decreased progeny release from cells infected with a transplant derived viral isolate. In conclusion, treatment of human salivary gland cells with each of the three drugs produced modest decreases in BKPyV genome replication. These data highlight the need for continued studies to discover more effective and less toxic drugs that inhibit BKPyV replication in salivary gland cells.
HIV-associated Salivary Gland Disease
2009, Oral and Maxillofacial Surgery Clinics of North America
Citation Excerpt :
With regard to the observation of BLEC, as previously mentioned, BLEC have a slow progression; therefore, any sudden increases in gland size warrant immediate investigation because of the risk of lymphomatous transformation. Fine-needle aspiration (FNA) has been shown to be an effective diagnostic tool for monitoring BLEC for the development of EBV-associated malignant B-cell lymphoma, of which these patients are at an increased risk.28 Even though a relationship between BLEC and malignancy is not well documented, HIV patients have a higher incidence of malignant lymphoma, thus necessitating routine (every 6 months) follow-up.
Mucocutaneous candidiasis
2008, Piel
Rare post-tonsillectomy complication in human immunodeficiency virus positive patient: Ulcero-necrotic lesion of tonsillar fossa
2009, Journal of Laryngology and Otology
Benign Lymphoepithelial Cyst of Parotid Glands in HIV Infected Patients on Anti-Retroviral Therapy: A Narrative Review
2023, Indian Journal of Otolaryngology and Head and Neck Surgery

View all citing articles on Scopus

: Address reprint requests to Lauren L. Patton, DDS, Department of Dental Ecology, CB #7450, 388 Dental Office Building, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7450, email:[email protected]

View full text