Oral medicine
Comparative study of the effect of antiretroviral therapy on benign lymphoepithelial cyst of parotid glands and ranulas in HIV-positive patients

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Objective

This study's aim was to assess the effect of highly active antiretroviral drugs (HAART) on benign lymphoepithelial cysts (BLEC) of the parotid and ranulas.

Study design

The records of 10 HIV-positive patients who presented with BLEC were reviewed, and 14 HIV-positive patients who presented with ranulas were prospectively enrolled. Patients in both groups received the same combination of HAART and were clinically evaluated for the first 3 months. Patients with ranulas were followed for an additional 3 months. A clinical reduction in the size of the lesions was considered to be a positive outcome.

Results

All parotid glands with BLEC resolved within 3 months. No positive results were observed in ranulas during the first 3 months. However, some of the ranulas displayed a positive result after the initial 3 months of HAART.

Conclusions

In contrast to BLEC, ranulas in HIV-positive patients seem to present a mixed and delayed response to HAART.

Section snippets

Patients and Methods

This was a clinical study with both retrospective and prospective components. It involved both pediatric and adult HIV-positive patients who presented with either an enlargement of the parotid glands or a ranula. In both components of the study, every patient acted as his/her own control. This reduced the effect of other confounding factors, such as age, gender, CD4+ cell count, and blood viral load.

Results

In Table I, the socioepidemiologic data and clinical results for the BLEC patients are summarized. In this retrospective study group, all 10 patients with BLEC displayed a positive result. The parotid gland swelling was completely reduced to a fraction of their initial size in 9 of the 10 patients. Figure 2 shows the initial and final clinical status of the enlarged parotid gland in one of the adult HIV-positive patients on HAART.

In the prospective study group (Table II), all of the 14 selected

Discussion

Enlargement of the parotid salivary glands, secondary to benign lymphoepithelial cysts, is the most described form of HIV-SGD. Not only is it a lesion frequently associated with HIV infection, but it is also a presumptive sign of a possible underlying HIV infection in both pediatric and adult patients. The prevalence of ranulas in HIV-positive patients is not well defined. In the specific context of the southern Africa region, where the prevalence of HIV infection is recognized to be

Conclusions

The retrospective component of this clinical study supports what has already been reported in the literature about the beneficial effect of HAART on HIV-related parotid cysts. The need for parotid gland surgery has been reduced, especially for patients who qualify for HAART.

The results observed in the prospective component of this study suggest, with caution, that HAART does not equally influence the course of ranulas in HIV-infected patients. One should be patient and first implement HAART

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