Management of Patients with HIV Infection

HIV infection cannot be cured.
However, a great deal can be done to support patients with HIV infection and improve their quality of life.
In the U.K. services are well-developed, but this is not the case for the majority of patients with HIV infection.
HAART
The development of HAART (Highly Active Anti-Retroviral Therapy) has had a major impact on the management of AIDS by slowing the progression to AIDS. Of relevance to dentistry:
Many oral lesions regress.
Although oral warts tend to increase in number and severity.
Side effects can include:
Dry mouth.
Increased melanin pigmentation of oral mucosa - this can be unsightly.
Perioral dysaesthesia.
HAART can suppress HIV replication for many years allowing the patient to live a relatively normal life free from the symptoms of AIDS.
Many systemic lesions regress and others, such as Non-Hodgkin's Lymphoma, are less likely to develop.
HPV infections increase and there is an increased risk of cervical cancer in women.
Although effective, HAART ultimately fails and HIV replication returns to high levels.
Development of new oral lesions is associated with failure of HAART.
HAART has only been available for a few years and is evolving all the time as new drugs become available, so the long term benefits and side effects remain unknown.
Drugs that suppress HIV in different ways are included together. For example, these include:
Reverse transcriptase inhibitors (e.g. AZT) that prevent reverse transcription of HIV RNA.
Protease inhibitors that prevent cleavage of newly synthesized HIV proteins.
This cleavage is essential for HIV replication.
The potential benefits of HAART are considerable, but:
It is expensive (unavailable to most patients with HIV around the globe).
It can be associated with poor compliance (too many tablets to take every day).
The side effects can be severe.
HIV resistance is becoming more common.
It ultimately fails in most patients.