Systemic Diseases
Oral Manifestations of HIV/AIDS
The oral cavity is an early sentinel of HIV disease; classical lesions include pseudomembranous candidiasis, oral hairy leukoplakia, Kaposi sarcoma and necrotising periodontitis.
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Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Oral Manifestations of HIV/AIDS figures pending faculty review.
§ overviewOverview
Spectrum of opportunistic infections, neoplasms and idiopathic conditions of the oral cavity associated with HIV infection and immunosuppression.
§ epidemiologyEpidemiology
Occur in 30–80% of untreated HIV patients; reduced markedly by ART.
§ clinicalClinical Features
- 01Pseudomembranous or erythematous candidiasis, angular cheilitis
- 02Oral hairy leukoplakia (EBV) — corrugated white patch on lateral tongue, cannot be wiped off
- 03Kaposi sarcoma — HHV-8, purple palatal macules/nodules
- 04Non-Hodgkin lymphoma
- 05Linear gingival erythema, necrotising ulcerative gingivitis/periodontitis/stomatitis
- 06Aphthous-like ulcers (major)
- 07Salivary gland disease with xerostomia and parotid enlargement
- 08HPV-associated warts
§ investigationsInvestigations
- 01HIV serology and CD4 count
- 02Biopsy of persistent lesions (KS, NHL, OHL)
- 03Fungal smear/culture
§ classificationClassification
- 01EC-Clearinghouse: Group I strongly associated (candidiasis, OHL, KS, NHL, periodontal), Group II less commonly associated, Group III seen in HIV
§ treatmentTreatment
- 01Initiate/optimise antiretroviral therapy (mainstay)
- 02Candidiasis: topical nystatin/miconazole; systemic fluconazole for refractory
- 03OHL: aciclovir; recurs on stopping
- 04KS: ART ± intralesional vinblastine, radiotherapy, chemotherapy
- 05NUP: debridement + metronidazole + chlorhexidine + amoxicillin
- 06Standard universal infection control
§ complicationsComplications
- 01Systemic opportunistic infections
- 02Progression to AIDS
- 03Pain, dysphagia, weight loss
§ prognosisPrognosis
Excellent when ART maintains CD4 and viral suppression; lesions often regress.
§ examKey Examination Points
- 01OHL and NUP are highly suggestive of HIV — investigate
- 02Check CD4 before invasive procedures
§ revisionQuick Revision Summary
- 01Candidiasis · OHL · KS · NUP · ART is definitive treatment
§ vivaBDS Viva Questions
- 01List the EC-Clearinghouse Group I lesions.
- 02How does OHL differ from candidiasis?
- 03Universal precautions in dental practice?
§ mcqsMCQs — Assessment (3)
Question 1
Cause of oral hairy leukoplakia:
Question 2
Kaposi sarcoma is associated with:
Question 3
OHL characteristically:
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Tumours Online — Head and Neck
IARC / WHO · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 1
- L2 · Guideline — 1
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Clinical Guidelines
Pappas PG, Kauffman CA, Andes DR et al.. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016 · 62(4):e1-50
IDSA clinical practice guideline covering oropharyngeal, oesophageal and invasive candidiasis management.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- EC-Clearinghouse on Oral Problems in HIV 1993
- Reznik DA. Top HIV Med 2005
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.