Oral Manifestations Of HIV Infection Research Articles

Dental and oral lesions in HIV infected patients: a study in Brazil

To determine the prevalence of dental and oral lesions, as well as treatment need, in a group of HIV sero-positive Brazilians. In addition, to test the association between oral manifestation of HIV infection and age, sex, mode of transmission and drug therapy. All HIV seropositive patients attending a dedicated dental clinic in Recife were invited to participate in the study. They were all examined by one trained and calibrated examiner and interviewed by one trained interviewer. 161 of 204 patients (78.9%) agreed to participate in this study. Most of the participants were male (76%), had acquired HIV sexually (74.5%), and were taking some form of antiretroviral therapy (70.8%). 33.5% had one or more oral manifestation of HIV. Candidiasis was the most common (28.6%), followed by hairy leukoplakia (9.3%), Kaposi sarcoma (2.5%), ulceration (2.5%), herpes simplex (1.2%), papiloma (0.6%), and 4.4% had periodontal disease. Only 1.2% reported xerostomia. There were no differences in the prevalence of oral manifestations of HIV infection between age groups, sexes, modes of transmission and types of drug therapy (P>0.05). The mean DMF-T score was 19 (SD 8) and 78.9% needed some form of dental treatment. While the prevalence of oral manifestations of HIV/AIDS was low in this sample of HIV seropositive Brazilians, dental status was poor and need for dental treatment was high.

Oral manifestations of HIV infection in relation to clinical and CD4 immunological status in northern and southern Thai patients.

To assess prevalence and variations in the oral manifestations of HIV in HIV-infected subjects in southern Thailand (a new HIV epidemic) and northern Thailand (a mature epidemic), and the association with age, sex, risk behaviours, CD4 count and medication used. A total of 102 and 135 HIV-infected individuals were enrolled in northern and southern hospitals, respectively. Oral and haematological examination was performed after sociodemographic interview of the patients. Clinical history was retrieved from patients' medical records. Oral candidiasis (OC, 55%), oral hairy leucoplakia (OHL, 21%) and HIV-associated-periodontal disease (14%) were among the most common oral lesions in southern Thailand. OHL (38%), OC (25%), HIV-associated-periodontal disease (15%) were the three most common lesions in the north. A significant association was found between any oral lesion, OC, particularly the pseudomembranous type (PC), and CD4 < 200 cells mm(-3) at both sites. A negative relationship was found between systemic antifungal treatment and OC including PC and erythematous candidiasis (EC) in the southern data. OHL showed a positive relationship with male sex and a negative relationship with antiretroviral treatment in the northern site. Younger age and being a current smoker were positively associated with oral lesions in the southern group. OC, particularly PC, could be useful as a marker for immunosuppression, particularly where CD4 count cannot be determined routinely. Antifungal treatment is of benefit in the subjects who cannot afford highly active antiretroviral therapy (HAART).

Prognostic significance of HIV‐associated oral lesions and their relation to therapy

The oral manifestations of HIV infection have been considered to be of value in assessing disease progression in the developed world. However, the potential use of oral lesions as prognostic markers in resource-poor countries has yet to be fully investigated. There is reasonably compelling evidence in the developed world for an association between oral lesions and viral load. However, the true nature of this association is less clear and there are few data available from the developing world. With the introduction of HAART, a change in prevalence of the oral manifestations of HIV infection has been observed, including regression of oral candidiasis, Kaposi's sarcoma and oral hairy leukoplakia. However, oral condylomata and herpes simplex virus infection appear to persist with HMRT therapy. Further research in partnership with resource-poor countries is required to document disease progression and the associated oral lesions in both adults and children.

Overview of the Fourth International Workshop on the Oral Manifestations of HIV Infection.

Overview of the Fourth International Workshop on the Oral Manifestations of HIV Infection.

Comments upon the opening of the Fourth International Workshop on the Oral Manifestations of HIV Infection, Skukuza, South Africa.

Comments upon the opening of the Fourth International Workshop on the Oral Manifestations of HIV Infection, Skukuza, South Africa.

Laser palliation of oral manifestations of human immunodeficiency virus infection

The author describes the use of lasers to palliate the oral manifestations of the human immunodeficiency virus, or HIV, infection. He discusses the advantages to both patients and dentists, but he does not address the use of lasers as a modality to treat or cure HIV infection. Many oral manifestations of HIV infection can be used as markers for degree of immunosuppression. These manifestations may be treated with antibiotics, analgesics and antineoplastics, which may interact and interfere with antiviral agents used to treat the disease and possibly may exacerbate it. The author describes laser palliation of the oral manifestations of three HIV-positive patients. Dentists will see more patients living longer with HIV as the disease becomes more treatable. Lasers have been shown to be effective instruments in palliation of oral manifestations of HIV infection.

Oral manifestations and dental status in paediatric HIV infection.

To describe the incidence and prevalence of oral manifestations of HIV infection in a population of perinatally infected children. Retrospective and prospective study of a cohort of perinatally HIV-infected children. Community hospital and community-based paediatric clinic. Forty perinatally HIV-infected children with a median age of 12 months were eligible and selected for the study, which included a medical chart review from birth and prospective follow-up. Each child was examined quarterly for oral manifestations, tooth eruption, and for 27 children, caries and periodontal status. The incidence of pseudomembranous candidiasis was 43% (95% CI, 27-58%) within 6 months of birth. Oral candidiasis (defined as pseudomembranous or erythematous) was positively associated with low CD4 counts and the occurrence of plaque. Children with low CD4 counts were also found to have fewer teeth than children with high CD4 counts, after adjusting for age. Oral manifestations are common in paediatric HIV infection and are possible predictors of HIV disease progression. Primary care of HIV-infected children should include periodic oral examinations to monitor their HIV disease progression and to alleviate symptoms associated with oral opportunistic infections.

Oral manifestations of HIV infection in a group of predominantly ethnic Chinese.

A total of 32 HIV-infected, predominantly ethnic Chinese individuals from Hong Kong were examined for oral mucosal lesions over a period of 1 year. The commonest oral lesion found was minor aphthous ulceration (27.4%), while xerostomia (17.8%), ulceration NOS (not otherwise specified; 12.3%), hairy leukoplakia (11.0%) and erythematous candidiasis (6.9%) were less frequent; Kaposi's sarcoma was notable for its absence. When the relationship between the number of oral lesions with age, risk group, medication taken, CDC staging and CD4+ count of the study group was investigated, a significantly higher number of oral lesions was associated with use of AZT, homosexuals and CDC stage IV; in contrast, a smaller number of lesions was found in those on antiparasitics and multivitamins (all P<0.05). When compared with studies from other parts of the world, the frequency of oral lesions appeared to be less common in the current study group. However, due to a lack of similar studies from the Asian region, especially in ethnic Chinese, it is not clear whether this difference could be attributed to racial, social or geographic factors.

Oral manifestations of HIV Infection in 600 South African patients: Arendorf TM, Bredekamp B, Cloete CAC, et al. J Oral Pathol Med 27:176, 1998

Oral manifestations of HIV Infection in 600 South African patients: Arendorf TM, Bredekamp B, Cloete CAC, et al. J Oral Pathol Med 27:176, 1998

Oral health behaviour and the prevalence of oral manifestations of HIV infection in a group of HIV positive adults

The objectives of this study were to assess the prevalence of oral manifestations of HIV infection, the periodontal health status and the oral health behaviour of a group of 51 HIV infected adults. The design was a cross-sectional descriptive study which took place in a community dental clinic in south London dedicated to treatment of this group of patients. Data were collected through a self-administrated questionnaire, interview and clinical examination and results showed that 76.5 per cent had one or more oral manifestations of HIV infection. Intra-oral herpes, papilloma and non-Hodgkin's lymphoma were not identified. A very positive attitude towards oral hygiene was identified. Plaque levels were low. All individuals studied had some evidence of bleeding gums.

Oral manifestations of HIV infection by gender and transmission category in Mexico City.

A cross-sectional analysis was conducted in Mexico City from September 1989 to March 1996, to determine the prevalence of HIV-related oral manifestations by gender and route of HIV transmission. The diagnosis of HIV-associated oral lesions was based on preestablished criteria. For the statistical analysis chi-squared and Fisher's exact tests were used where appropriate. Odds ratios were calculated as estimates of the relative risks. Control of confounding factors was performed by logistic regression models. Oral lesions were present in 75% of 436 HIV+ patients. Hairy leukoplakia, erythematous and pseudomembranous candidosis, angular cheilitis and oral ulcers were frequently found. Patients who contracted HIV through blood transfusion were more likely to present erythematous candidosis (P=0.005) than subjects who acquired HIV through sexual transmission. Oral ulcers were seen only in men (P=0.02) and in individuals who contracted HIV through sexual transmission (P=0.02). This study brings valuable data in regard to differences in the type and prevalence of HIV-related oral lesions by gender and the risk categories analysed, particularly blood transfusion.

The oral manifestations of HIV infection.

The oral manifestations of HIV infection.

Some unusual oral lesions in HIV infection: comments on the current classification.

Of the numerous oral lesions reported in HIV-infected patients, four entities will be discussed in this paper: linear gingival erythema; cystic lymphoid hyperplasia of the parotid gland; oral non-Hodgkin's lymphoma; and oral squamous cell carcinoma. Based on the literature and the author's personal experience, it appears that linear gingival erythema is perhaps a specific HIV-associated periodontal lesion, but that insufficient data are available in the literature yet to classify this periodontal lesion as a lesion that is strongly associated with HIV infection. On the other hand, cystic lymphoid hyperplasia of the parotid gland has been rather widely reported and has characteristic histopathological features that would justify consideration of this lesion as highly indicative of an underlying HIV infection. Oral non-Hodgkin's lymphoma, at present regarded as a lesion 'strongly associated with HIV infection', is less characteristic in this respect and should merely be classified as 'a lesion seen in HIV infection'. Oral squamous cell carcinomas, not included in the most recent International Classification of Oral Manifestations of HIV infection, should be listed in Group 3 of that classification, representing 'lesions seen in HIV infection'. Further criteria should be developed that will enable distinctions to be made between lesions 'strongly associated with', 'less commonly associated with', and 'seen in' HIV infection.

Oral manifestations of HIV infection.

The oral manifestations of HIV infection are reviewed along with evidence supporting the need for training of health-care professionals in the recognition of oral lesions. The diagnosis, prevalence, pathogenesis, and management of the most common oral lesions observed in HIV infection are described. Oral candidiasis and hairy leukoplakia are two oral lesions that have been demonstrated to have important prognostic significance. The diagnosis and management of periodontal disease in seropositive patients is emphasized, and a preventive protocol for patients at risk for periodontal pathology is recommended.

Oral manifestations of HIV infection

Oral manifestations of HIV infection

5.2 HIV and oral disease

Oral manifestations of HIV infection often represent the first clinical signs of this disease. Early management of oral lesions reduces the prospect of what would normally be routine procedures in the mouth becoming compromised and complicated when the immune system is further suppressed.

Increasing access to dentists by HIV+ people: An intervention strategy

There is ample evidence of problems of access to oral health care for HIV+ people. This situation is particularly unfortunate because of the importance of absence of infection in people who are immunocompromised and because oral manifestations of HIV infection are important markers of the progress of the disease. An experimental intervention protocol designed to increase access to oral health care for people who are HIV+ is described. The interventions used theoretical perspectives associated with cognitive constructions of anxiety and avoidance and with social learning theory. The interventions combined educational and cognitive behavioral techniques including reframing and modeling. Although there was some preliminary evidence of a positive effect among younger dentists, unanticipated problems associated with the complexity of the research design compromised the effectiveness of the interventions. Explanations for the absence of positive findings are supplied, as well as suggestions for implementing successful educational interventions intended to induce behavioral change.

BOOK REVIEWS

Book reviewed in this article:Oral Manifestations of HIV Infection J.S. Greenspan and D. GreenspanFundamentals of Pediatric Dentistry, Third ed. R.J. Matheson and R.E. Primosch

Book Reviews

Melnick SL, Nowjack‐Raymer R, Kleinman DV, Swango PA. A guide for epidemiological studies of oral manifestations of HIV infection.Thylstrup A, Fejerskov O (Editors). Textbook of clinical cariology, 2nd edn.

Oral manifestations of HIV infection in homosexual men and intravenous drug users: Study design and relationship of epidemiologic clinical, and immunologic parameters to oral lesions

This article describes the baseline findings from a study designed to compare the oral manifestations of HIV infection in homosexual men and intravenous drug users. Both seropositive and seronegative persons were studied. A standard examination instrument was developed to record indexes of oral disease as well as to record the presence of oral lesions. The two groups differed in terms of education, race, socioeconomic status, employment status, housing, and smoking experience. The prevalence and type of oral lesions differed in the two seropositive groups. In seropositive homosexual men, white lesions on the tongue (28.4%) predominated; whereas for the seropositive intravenous drug users, oral candidiasis (43.0%) and gingival marginal erythema (33.3%) were most often detected. We also observed that seronegative intravenous drug users displayed a greater number of oral lesions than seronegative homosexual men. For seropositive homosexual men, lesion presence was significantly associated with decreased levels of CD4; positive associations were seen with current smoking, antiviral drug use, and antibiotic use, and a negative association was observed with current employment. In contrast, only exposure to antiviral drugs was significantly correlated with lesion presence for seropositive intravenous drug users. This baseline analysis from our longitudinal study suggests clear differences in oral manifestations of HIV infection between seropositive homosexual men and intravenous drug users and between seronegative homosexual men and intravenous drug users. Among other parameters, it is apparent that lifestyle, access to health care, and the condition of the oral cavity before infection influence the development of oral lesions in persons with HIV infection.