a i d s dr shabeel pn

ORAL MANIFESTATION OF HIV INFECTIONS What is the importance ? Oral cavity can be easily examined Common Early recognition diagnosis and treatment may reduce morbidity Early diagnostic indicator May change the staging Predictor of progression of HIV done

Fungal lesions Viral Bacterial Neoplastic Minor oral ulcers

FUNGAL LESIONS Oral Candidiasis Candida albicani Candida glabrata and C.tropicalis Common oral manifestation of acute stage of HIV infection

Occur with falling CD4 + T cell count in middle and late stages of HIV Other predisposing factors, are infancy, old age, antibiotic therapy, steroids and other immunosuppressive drugs, xerostamia, anaemia, endocrine disorders, primary and acquired immunodeficiency.

CLINICAL FEATURES Burning mouth, problems eating spicy food and changes in taste. Clinical appearance varies Common are pseudomembranous and erythematous candidiasis

HISTOPLASTOMIES Appear as oral ulcers Diagnosis requires biopsy Cryptococcus neoformans Ulcerated mass in the hard palate. Biopsy of palatal ulcer is diagnostic.

VIRAL LESIONS Painful persistent large intraoral ulcers Buccal/ labial mucosa 27%, tongue 25%, gingiva – 18%

Recurrent herpes simplex (H.Labialis, cold sores) Develop on the lips Intraorally in the keratinised mucosa of palate and gingiva. Begins as a burning sensation followed by small coalseing vesicles. Ulcer surrounded by erythematous halo No scan formation Importance – Patients with advanced HIV disease may present several recurrence a year especially characterized by large confluent and extremely painful ulceration.

HERPES ZOSTER Painful oral lesion or tooth ache Usually unilateral Follow the distribution of maxillary and /or mandibular branches of trigeminal nerve.

Human Papilloma Oral wart Papilloma

CYTOMEGALOVIRUS Confused with aphthous ulcers, necrotizing ulcerative periodontitis and lymphoma Aphthous ulcer CMV Diagnosis by biopsy and immunohistochemistry

HAIRY LEUKOPLAKIA Non movable corrugated or hairy white lesion on the lateral margins of tongue. Occurs in 20% of person with asymptomatic HIV infection Becomes more common as the CD4+T cell count falls Non HIV patients who are affected are recipients of bone marrow, cardiac and renal transplants

BACTERIAL INFECTION Periodontal Disease Necrotising ulcerative periodontitis - Rapid and severe course Linear gingival erythema – relative mild form

MYCOBACTERIUM AVIUM INTRACELLULARE Palatal and gingival granulomatous masses Diagnosed by AFB staining of biopsy specimens

NEOPLASTIC LESION This may occur intraorally either alone or association with skin and disseminated lesion. Common in men First manifestation of late stage of HIV

DIFFERENTIAL DIAGNOSIS Vascular lesion – haematoma, haemangioma Pyogenic granuloma Bacillary angiomatosis Oral melanotic macules No bleeding associated with a biopsy of oral KS aspiration prior to biopsy may be useful to rule out haemangioma. Sudden appearance is characteristic.

LYMPHOMA Firm painless swelling that may be ulcerated Occur anywhere in the oral cavity Soft tissue involvement Bony involvement

DIFFERENTIAL DIAGNOSIS Confusion with major aphthous ulcers and rarely pericoronitis associated with an erupting third molar Diagnosis made by histologic examination of biopsy specimen.

OTHER ORAL LESIONS Recurrent Aphthous ulcers (RAU) Cause unknown – Stress and unidentified infectious agents Minor RAU – Well circumscribed with erythematous margin. Solitary lesion of 0.5-1cm Herpetiform type RAU- Clusters of small ulcers

Major RAU – Extremely large necrotic ulcer 2-4cm Idiopathic thrombocytopenic purpura may first manifest as oral lesion in HIV infected patients Xerostomia

Oral manifestation in children with AIDS Children infected with HIV develop severe immunosuppression very early Earlier than adults Fungal infections are more

DIAGNOSIS Detection of antiviral protein CD4+ T Cell count – oral abnormalities result from changes in the immune status of HIV carrier – Due to reduction in the number of CD4 + T cells and / or modification of CD4 / CD8 ratio. Increased T8 cells in germinal centres.

TREATMENT Most of the opportunistic infections are incurable. But by aggressively treating the acute disease, the infection can be controlled and suffering of patient decreased.

Cryptococcus – Amphotericin B 0.5- 0.8mg/kg/d iv Bacterial- Ampicillin Trimethoprim- Sulphamethoxazole Chloramphenicol Ceftriaxone Viral - Ganciclovir IV

PREVENTION Teach ABC of AIDS prevention Abstrain Be faithful Use Condom Dental Surgeons – High risk category - use gloves, Goggles, Facemask. Every patient is HIV positive until other wise proved.

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