Oral Lesions in HIV infection

Oral lesions were recognized in the earliest descriptions of HIV disease.
It subsequently became apparent that oral lesions had important relationships to:
Immune status.
HIV viral load.
Progression and stage of HIV disease.
For example, oral candidiasis and Hairy Leukoplakia correlate with:
Low CD4 counts (a marker of immune suppression)
High HIV viral load.
The clinical severity of HIV infection.
Mucosal lesions are often the earliest clinical indication that a patient has HIV infection.
Accordingly, a patient with undiagnosed HIV infection may present to the dental team.
Early diagnosis is important in optimising overall management.
A wide range of different oral mucosal lesions have been described.
A good summary of these remains 'Classification and diagnostic criteria for oral lesions in HIV infection'.
Journal of Oral Pathology and Medicine 1993; 22: 289-291.
This short paper was distributed in the lecture. Read it.
Group 1 lesions that are strongly associated with HIV infection include:
Candidiasis
Erythmatous candidiasis.
Pseudomembranous candidiasis.
Hairy Leukoplakia.
Kaposi's Sarcoma.
Non-Hodgkin's Lymphoma.
Periodontal Disease.
Linear Gingival Erythema
Necrotising (Ulcerative) Gingivitis.
Necrotising (Ulcerative) Periodontitis.
Also look at HIVdent: (www.HIVDENT.org/main.htm)
This is a very good web site aimed at dentists that includes:
Brief descriptions of the oral manifestations of HIV infection.
Accompanying photographs.
Advice about treament planning and provision of dental care.
HAART has a major impact on oral lesions due to HIV infection and is considered below.
Tobacco smoking is associated with an increase in oral lesions (except Recurrent Oral Aphthous Ulceration).
Candidosis and HIV-periodontal disease are likley to be more exagerated in smokers.
In contrast to other oro-facial lesions, salivary gland enlargement with associated xerostomia and CD8 positive lymphocyte infiltration is a good prognostic sign:
Progression to end-stage AIDS tends to be delayed in these patients.