AtlasSystemicOral Manifestations of HIV/AIDS

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.

OHL cause
EBV
KS cause
HHV-8
Definitive Rx
ART

§ 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:

References

  1. EC-Clearinghouse on Oral Problems in HIV 1993
  2. Reznik DA. Top HIV Med 2005

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.