Oral manifestations of HIV disease

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T he spectrum of oral clinical signs and symptoms in HIV-infected patients is very wide and its study is of great importance. Knowledge concerning the nature, clinical and laboratory significance, and treatment of the oral lesions in HIV-infected patients has grown during the last two decades. Indeed, oral lesions in this group of patients have been used as indicators and early clinical signs not only of HIV disease but also of the disease progression and as criteria for entry into clinical trials.1,2 The oral cavity is easily examined by clinicians, and oral lesions can often be diagnosed on clinical grounds alone; however, the wide spectrum of oral lesions and diseases may present difficulties in the differential diagnosis, and laboratory confirmation is necessary for accurate diagnosis. It should be stressed that the oral lesions in HIV infection are indicators and not truly specific for HIV disease as several of them can also be found in non-HIV-infected patients. They should always be regarded as markers of HIV disease in correlation with the medical history and with other clinical and laboratory studies, particularly in cases where HIV status is unknown. The oral lesions are mainly a result of cellular immunodeficiency due to HIV infection and are etiologically divided into five major groups.3–7 These include (1) infections (viral, bacterial, fungal); (2) neoplasms; (3) drug reactions; (4) neurologic manifestations; and (5) lesions of unknown cause. These lesions may represent early or late manifestations of HIV disease; they may be common or rare, and the oral clinician should be familiar with all of them. A classification of oral lesions into three groups has been proposed and is still internationally accepted.3 Group 1 lesions are strongly associated with HIV infection, group 2 lesions are less commonly associated with HIV infection, and group 3 lesions are seen in HIV infection (Table 1); however, further criteria that will enable the distinctions among lesions of the three groups should be developed.8 Presumptive and definitive diagnostic criteria have been described for several oral lesions and are based on the clinical features, histopathologic and microbiologic findings, and causative pathogens.3,9 Finally, it should be emphasized that a dramatic reduction of oral lesions has been observed the last three years in HIV-infected patients due to successful therapeutic regimens with the new anti-HIV drugs.