Oral Manifestations of HIV: What Doctors Should Know

Oral Manifestations of HIV and AIDS: An In-Depth Look
HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome) continue to be significant global health concerns, with millions of individuals affected worldwide. While most discussions around these diseases focus on systemic effects, the oral manifestations of HIV and AIDS play a crucial role in diagnosis and patient management. For healthcare providers, especially medical students and doctors, understanding these manifestations is essential for early identification and improved patient care.

The Connection Between HIV, AIDS, and Oral Health
The immune suppression caused by HIV makes individuals vulnerable to a variety of opportunistic infections, many of which manifest in the oral cavity. Oral health can serve as a window into the progression of HIV, with certain conditions acting as early indicators of disease onset and immunosuppression. These manifestations are not only diagnostic markers but can also significantly impact a patient's quality of life, making treatment and prevention a priority in comprehensive HIV care.

Common Oral Manifestations of HIV and AIDS
1. Oral Candidiasis (Thrush) Oral candidiasis, caused by Candida species, is one of the earliest and most common oral manifestations of HIV. Patients typically present with white, curd-like plaques on the tongue, palate, or buccal mucosa, which can be wiped away, leaving a red base. It often indicates a significant drop in CD4 cell count and may require systemic antifungal treatment in addition to topical therapies.

For more on oral candidiasis in HIV patients: www.cdc.gov/hiv/clinical-care/oral-candidiasis

2. Oral Hairy Leukoplakia This condition, caused by the Epstein-Barr virus (EBV), manifests as white, corrugated lesions on the lateral borders of the tongue. Unlike candidiasis, these lesions cannot be scraped off. Oral hairy leukoplakia often correlates with immunosuppression and is more commonly seen in individuals with advanced HIV infection.

Detailed info on Oral Hairy Leukoplakia: www.ncbi.nlm.nih.gov/pmc/articles/PMC6340362

3. Periodontal Diseases HIV-infected individuals are at higher risk for severe forms of periodontal diseases, including:

• Necrotizing Ulcerative Gingivitis (NUG): Characterized by rapid destruction of gingival tissue.
• Necrotizing Ulcerative Periodontitis (NUP): More severe than NUG, with rapid bone loss and painful symptoms.

​

Both conditions can result in rapid deterioration of oral structures and require aggressive periodontal therapy alongside systemic antimicrobial treatment.

Learn more about HIV-related periodontal diseases here: www.journalofperiodontology.com/hiv-periodontitis

4. Kaposi’s Sarcoma Kaposi’s sarcoma is a cancer often associated with late-stage AIDS. It appears as purplish, flat or raised lesions on the palate, gingiva, or other oral mucosal surfaces. This vascular malignancy is caused by Human Herpesvirus 8 (HHV-8) and is often a sign of severe immunosuppression. Early detection of oral Kaposi’s sarcoma is critical in managing the overall health of HIV patients.

For more details on Kaposi’s Sarcoma: www.cancer.gov/types/kaposi/hiv-patients

5. Recurrent Herpes Simplex Virus (HSV) Infection While HSV can affect anyone, HIV-positive patients often experience more severe and prolonged outbreaks, particularly on the oral mucosa. Recurrent lesions, commonly known as cold sores, are painful and can affect eating and speaking. These lesions are often an indication of advanced immune system compromise.

Detailed info on HSV in HIV patients: www.hopkinsguides.com/hiv-herpes-simplex-virus

6. Human Papillomavirus (HPV)-Related Lesions HPV-related oral warts are also commonly seen in HIV patients, manifesting as small, papillomatous growths on the oral mucosa, lips, or tongue. These lesions vary in appearance and may be difficult to distinguish from other oral pathologies.

More about HPV and HIV: www.aidsmap.com/hpv-oral-lesions

7. Salivary Gland Disease Enlargement of the salivary glands and xerostomia (dry mouth) are common in HIV-positive patients. The decreased salivary flow can lead to difficulties in speaking and eating and increases the risk of dental caries and oral infections.

Learn more: www.ada.org/hiv-dental-salivary

8. HIV-Associated Ulcerative Conditions These include recurrent aphthous ulcers (canker sores), which can be more extensive and severe in HIV-infected individuals. These painful lesions can significantly impair oral function and nutrition.

9. Lymphoma Oral non-Hodgkin's lymphoma, though rare, is another manifestation that may appear in HIV patients, especially those with a low CD4 count. It typically presents as a rapidly growing mass that can be painful or asymptomatic.

The Importance of Early Diagnosis and Treatment
Recognizing the oral manifestations of HIV can lead to early diagnosis and better management of the disease. For many patients, oral lesions may be the first sign of immunosuppression, particularly in individuals who may not be aware of their HIV status. This makes oral examinations an integral part of routine HIV care, especially in settings where access to healthcare is limited.

Early detection of oral lesions can also help in the timely initiation of antiretroviral therapy (ART), which can reduce viral load, improve immune function, and prevent further complications. Proper management of these oral conditions is crucial for maintaining patient comfort, nutrition, and overall quality of life.

Treatment and Prevention
The management of HIV-related oral manifestations often involves a combination of systemic and local therapies. For conditions like oral candidiasis, antifungal treatments such as nystatin or fluconazole are commonly prescribed. Viral infections like HSV or HPV may require antiviral medications, while more aggressive diseases like Kaposi’s sarcoma or lymphoma may necessitate chemotherapy or radiation.

In addition to treating existing lesions, prevention is key. Maintaining good oral hygiene, regular dental check-ups, and early ART initiation are essential strategies to minimize the occurrence and severity of these conditions.

Conclusion
Oral manifestations of HIV and AIDS offer critical insights into the progression of the disease. They serve not only as markers for immune suppression but also as essential elements of comprehensive care for individuals living with HIV. As medical professionals, early recognition and appropriate treatment of these conditions can greatly enhance the quality of life for HIV-positive patients.