THE IMPORTANCE OF EARLY RECOGNITION OF ORAL POTENTIALLY MALIGNANT DISORDERS IN HIV-AIDS INDIVIDUALS.

Abstract

Objective An increase in head and neck cancer (HNC) in HIV-infected individuals has been described in several epidemiological studies, suggesting that immunosuppression, even in treated patients, may play a role in the development of HNC. A thorough oral examination is essential for the identification of potentially malignant lesions, particularly in individuals at high risk to develop cancer. Thus, we report two cases of oral potentially malignant disorders occurring in HIV individuals. Clinical Presentation Case 1. A 39-year-old male HIV+ since 2013. In 2015 presented an asymptomatic, slightly granular, red/white pediculate tumor on the left buccal mucosa, clinically compatible with multifocal epithelial hyperplasia with post-traumatic hyperkeratosis (251 cells/ml CD4+, undetectable viral load [VL]). Two weeks later, the lesion showed marked erosive/ulcerated areas, thus, a complete excision was done. The final diagnosis was in situ squamous cell carcinoma positive to HPV-16. Case 2. A 40-year-old male HIV+ since 2005, with histologically confirmed oral hairy leukoplakia, immunohistochemistry showed positive expression to EBV and negative to HPV. In 2015 presented a white well circumscribed homogeneous plaque, with a slightly rough surface and some satellite lesions, comparable with the previous hairy leukoplakia. The patient referred itching and burning sensation, so an excisional biopsy was done, showing hyper orthokeratosis with moderate dysplasia. The sample was negative for EBV and HPV. Both patients have remained asymptomatic, without signs of recurrence. Outcome The present cases evidence that some oral potentially malignant disorders may resemble other common lesions in HIV-patients that could be underdiagnosed, delaying an appropriate management and impacting prognosis. It is essential to highlight that HIV/AIDS patients should be closely monitored. Oral examination should be cautious even in the presence of lesions with a benign appearance.