广西地区64例人免疫缺陷病毒感染及艾滋病感染患者口腔病损的临床观察

目的　了解广西人免疫缺陷病毒感染及艾滋病感染(HIV/AIDS)患者口腔病损状况,为我国HIV/AIDS人群口腔疾病的防治提供依据。方法　以经广西区疾病控制中心确诊为HIV/AIDS患者64例为调查对象,由专业人员采集病史,进行口腔专科检查,并将详细记录的结果与世界卫生组织艾滋病感染口腔表征协作中心制定的艾滋病口腔表征分类及诊断标准相比较。结果　64名HIV/AIDS患者,年龄范围为5月~64岁,平均年龄36·1岁,其中男53人,女11人。48名有口腔主诉,以口干、疼痛、吞咽困难为主;口腔表现为口腔念珠菌病39例、口干症20例、口腔溃疡11例、艾滋病相关的牙周病7例、单纯疱疹病毒感染口炎6例、带状疱疹3例、口腔毛状白斑2例、卡波济肉瘤和淋巴节炎各1例。结论　口腔念珠菌病是HIV/AIDS患者最常见的口腔表征,多数患者伴有口干、唾液分泌减少。口腔溃疡患病率与正常群体相比没有提高,但是溃疡严重程度增加。提示HIV/AIDS患者常伴有口腔表征, 并且部分口腔表征出现较早。     

HIV/AIDS患者口腔病损的临床特点分析

目的了解艾滋病相关口腔病损的临床特点及其与CD4计数和高效抗逆转病毒治疗（highly active antiretroviral therapy,HAART）之间的关系。方法回顾性研究2012~2013年在我院收治的109例HIV/AIDS患者的临床资料,包括流行病史、艾滋病临床阶段、口腔表现、全身症状、CD4计数、治疗及预后等,通过Excel建立数据库,进行统计学分析。结果 109例HIV/AIDS患者中48例出现艾滋病相关口腔病损,其中口腔念珠菌感染48例（44.03%）,以假膜型为主,口腔深大溃疡5例（4.59%）,卡波西肉瘤和淋巴瘤各2例（1.83%）,牙龈线型红斑、口腔单纯疱疹和口腔疣各1例（0.92%）。CD4〈200个/ul组口腔病损的发生率高于CD4≧200个/ul（P〈0.01）,HAART治疗组口腔病损的发生率低于未治疗组（P〈0.01）,差异有显著性。结论口腔是HIV/AIDS患者最常见的机会性感染部位。口腔病损中以假膜型口腔念珠菌病最常见,其次是口腔深大溃疡、口腔恶性肿瘤。卡波西肉瘤和淋巴瘤死亡率高,早期口腔表现易与淋巴结炎、牙龈炎混淆,应尽早进行病理检查,早期诊断。HIV/AIDS患者口腔病损的发生与CD4计数减少有关,HAART治疗能显著降低口腔病损的发生。     

HIV感染者HPV相关口腔损害研究现状

艾滋病病毒（HIV）的感染尤其是高效抗逆转录病毒治疗,使口腔人类乳头状瘤病毒（HPV）感染的感染率增加。本文旨在对HIV感染相关的HPV口腔流行病学特征和基因型分布等方面的国内外的研究进展进行综述。     

HIV感染与牙周疾病相关性的研究进展

艾滋病(AIDS)是由感染人类免疫缺陷病毒(HIV)引起的人体免疫功能缺陷疾病,近年来,与艾滋病相关的慢性疾病的研究引发了学者的广泛关注。人们对与HIV相关的慢性病及其相互关系的研究日益增多。HIV感染后很长一段时间没有明显的临床症状,但多数患者在早期就可能出现各种口腔病损,如白色念珠菌病、口腔毛状白斑、HIV相关性牙周病变、卡波西肉瘤以及非霍奇金淋巴瘤等,其中HIV相关性牙周病变较常见。因此,通过牙周组织检查对艾滋病的早期发现具有重要意义。本文将从HIV感染患者的牙周病变表现以及艾滋病与牙周病变发展的关系予以综述。     

人免疫缺陷病毒相关性牙周病

根据人免疫缺陷病毒(HIV)感染口腔表现的分类标准。HIV相关牙周病被认为是与HIV感染密切相关,发生率较高的口腔病变。是艾滋病(AIDS)的早期临床表现。故牙周医师了解其临床特点对早期诊断AIDS、避免误诊和交叉感染有重要意义。本文介绍了HIV相关牙周病的分类、流行病学、临床表现、发病机理和治疗方案。     

口腔综合治疗台的卫生新概念

口腔医疗设备和器械是口腔诊治工作的基本设备和工具。口腔疾病的诊治操作多数是在口腔内进行的。操作中常会触及唾液和血液。患有传染性疾病的病员或无症状的携带者的唾液和血液中存在着大量的病员微生物，如乙肝病毒（HBV）、艾滋病病毒（HIV）、结核杆菌、麻疹病毒、巨细胞病毒和泡疹病毒等。它们可通过各种途径造成医患之间，患者之间的交叉感染，这已被大量的实验和临床研究所证实。     

人类免疫缺陷病毒(HIV)感染的口腔表现及其处理——Ⅱ.较常见的病变

淋巴结肿大颈淋巴结肿大是初期急性腺源性发热、HIV感染和艾滋病的共有特征,也可累及涎腺内淋巴结。念珠菌病口腔念珠菌病常是HIV感染的初期症状表现,并提示有食道念珠菌病和其他机会感染的可能。口腔念珠菌病作为HIV感染严重程度的标志。HIV疾病伴口腔干燥者更易发生念珠菌病。如无局部原因(口腔干燥、使用抗生素和皮质类固醇或其他免疫抑制剂)的年轻男性患者,则高度提示HIV感染。鹅口疮是HIV感染最明显的口腔病变之一。目前的研究可见到念珠菌病的其他类型,特别是红斑和增生性病变。红斑型     

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目的探索人类免疫缺陷病毒（HIV）感染或艾滋病（AIDS）患者口腔真菌定植状况及菌种分布,为HIV感染或AIDS患者真菌感染防治提供理论依据。方法选择2013年6—12月在新疆医科大学第一附属医院感染科就诊的HIV感染或AIDS患者30例,由口腔科采用咽拭子法收集口腔分泌物,通过真菌培养实验分析口腔真菌定植状况。结果 30例HIV感染或AIDS患者中,阳性带菌者19例,阳性率为63.3%。阳性带菌者年龄2~52岁;其中男13例（68.4%）、女6例（31.6%）;维吾尔族15例（78.9%）,汉族4例（21.1%）。阳性带菌者中携带白色念珠菌15例（78.9%）。结论白色念珠菌为HIV感染或AIDS患者口腔真菌定植的主要菌种。阳性带菌者年龄分布广泛。     

牙周支持治疗对HIV-血清阳性与HIV-血清阴性患者的长期效果比较

许多人类口腔疾病的表现与人类免疫缺陷病毒(HIV)感染有关,其中包括牙周疾病、口腔 Ka-posi肉瘤、非何杰金氏淋巴瘤,以及其他各种感染,这些因素都会累及牙周组织。本实验的目的是研究在HIV-血清阳性与HIV-血清阴性患者中长期牙周支持治疗的结果。     

口腔医疗机构艾滋病职业暴露及职业防护的研究进展

艾滋病（AIDS）是由人类免疫缺陷病毒（HIV）引起的一类传染性极强、蔓延速度快、病死率高的传染性疾病,是我国公众健康及传染病防治中的一个难题。口腔诊疗工作的特征,使口腔医疗机构/口腔科成为HIV/AIDS职业暴露的重点部门,医务人员面临较高的HIV/AIDS职业暴露风险。本研究对HIV/AIDS的流行状况及传播途径、HIV/AIDS患者口腔病变、口腔医疗机构HIV/AIDS职业暴露及职业防护的现状进行综述。     

口腔医疗机构艾滋病职业暴露及职业防护的研究进展

艾滋病（AIDS）是由人类免疫缺陷病毒（HIV）引起的一类传染性极强、蔓延速度快、病死率高的传染性疾病,是我国公众健康及传染病防治中的一个难题。口腔诊疗工作的特征,使口腔医疗机构/口腔科成为HIV/AIDS职业暴露的重点部门,医务人员面临较高的HIV/AIDS职业暴露风险。本研究对HIV/AIDS的流行状况及传播途径、HIV/AIDS患者口腔病变、口腔医疗机构HIV/AIDS职业暴露及职业防护的现状进行综述。     

促进农村地区AIDS患者及HIV携带者口腔健康措施的研究

目的 调查农村地区获得性免疫缺陷综合征(AIDS)患者及人类免疫缺陷病毒(HIV)携带者的口腔卫生知识、态度和行为(knowledge,attitude and practice,KAP)现状,评价相应的干预措施对提高其口腔卫生KAP及口腔健康水平的效果.方法 2009年5至8月对安徽省皖北某县4个行政村共82例AIDS患者及HIV携带者采用一对一匿名采集病史和现场口腔检查,对口腔卫生KAP及口腔疾患现状进行基线调查,根据调查结果 实施干预措施,比较干预前后AIDS患者及HIV携带者口腔卫生状况的改善情况及干预效果.结果 干预前82例AIDS患者及HIV携带者口腔卫生状况较差,干预后76例AIDS患者及HIV携带者相关口腔KAP提高,干预前认为"洗牙可以传播AIDS"者占27%(22/82),干预后为54%(41/76)(x2=20.066,P<0.001);AIDS相关口腔疾病患病率明显下降,干预前83%(68/82)的受访者有"牙龈炎",干预后为62%(47/76)(x2=8.852,P=0.003).由主观因素引起的个人口腔卫生及相关的KAP在干预后改善较好,干预前"每次刷牙超过3 min"者占44%(36/82),干预后为59%(45/76)(x2=4.017,P=0.045).结论 农村AIDS患者及HIV携带者口腔卫生KAP状况较差,干预后得到改善,口腔健康水平得到显著提高.

Abstract：

Objective To survey the status of oral cavity hygiene knowledge,attitude and practice (KAP)of rural acquired immunodeficiency syndrome(AIDS)patients and human immunodeficiency virus (HIV)carriers and take corresponding intervention measures to improve the oral health of these patients.Methods From May to August in 2009,the methods of anonymous face to face structured interview and oral examination at the scene were carried out at the baseline in rural AIDS patients/HIV-carriers.According to the results of the survey,intervention measures were taken.The results of the intervention and the oral hygiene status were compared before and after the intervention.Results The oral health status of 82 AIDS patients and HIV-carriers were in poor before the intervention,and the knowledge of AIDS-related oral health of 76 AIDS patients and HIV-carriers was promoted after interventions,"scaling can spread AIDS"were 22 cases(27%),and after the intervention 41 patients(54%)think that can spread(x2=20.066,P<0.001).The oral diseases of related AIDS were decreased dramatically,68 patients(83%)had gingivitis before intervention and 47 cases(62%)after the intervention(X2=8.852,P=0.003).The personal oral cavity hygiene and related oral KAP of AIDS caused by subjective hetors had improved to different extent,"brushing teeth over 3 min at every turn",there were over 36 cases(44%)before intervention and 45 patients after intervention(59%)(X2=4.017,P=0.045).Conclusions The oral hygiene and KAP of AIDS patients and HIV-carriers in rural areas were poor and improved after intervention.     

Common oral opportunistic infections in Human Immunodeficiency Virus infection/Acquired Immunodeficiency Syndrome: Changing epidemiology; diagnostic criteria and methods; management protocols

There were 36.9 million in the world living with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) as of 2017, and new infections have seen a reduction by 18% since 2010. But this rate of decline is not sufficient for the goal of eradication of AIDS by 2030. Only 21.7  million people infected with HIV have accesses to antiretroviral therapy, with the rest at risk of the potential complications of HIV infection. It has been shown that oral lesions are diagnostic and prognostic of HIV infection, and many oral opportunistic infections continue to be a major problem, particularly in developing countries. It is therefore important that dental surgeons be aware and updated to recognize and manage the oral effects of HIV infection/AIDS. This chapter describes the classification, diagnosis, and management of oral lesions in these patients, based on our current understanding of the infection. This review also discusses the standardization of diagnosis of oral lesions in HIV infection/AIDS patients, immune reconstitution inflammatory syndrome case definition, and the research priorities formulated at the 7th World Workshop on Oral Health and Disease in AIDS.     

Oral lesions as indicators of HIV infection among routine dental patients in Lagos, Nigeria

OBJECTIVES: To document the incidental oral lesions of human immunodeficiency virus (HIV) infection, the pattern and frequency of the lesions based on clinical presentation and oral manifestations in routine dental patients who tested positive in Nigeria. SUBJECTS AND METHODS: The study was conducted at the Oral Diagnosis/Oral Medicine clinic of the Lagos University Teaching Hospital, Lagos, Nigeria between May 2002 and April 2003. During this period, all patients with oral lesions suggestive of HIV/acquired immunodeficiency syndrome (AIDS) as described in the EEC-WHO Classification and diagnostic criteria of oral lesions of HIV were counseled and offered voluntary HIV testing. All the 35 patients who consented and tested positive were included in this study. RESULTS: Of a total of 700 patients 53 patients with oral lesions suggestive of HIV/AIDS were seen, thirty-eight (72%) consented to HIV screening, 15 patients (28%) refused. Thirty-five patients (92%), mean age 36 +/- 13 years were confirmed positive for HIV. Oral candidiasis was the commonest lesion seen (43%) the second common being Herpes zoster (23%). Other lesions seen included erythema multiforme in two (6%), facial palsy in two (6%) and oral hairy leukoplakia in one (3%). CONCLUSION: An oral mucosal lesion may be the presenting lesion of HIV/AIDS in routine patients attending the dental clinic. Oral health care workers should practice optimal infection control based on the Centers for Disease Control 'Standard Precautions' guidelines on infection control for all patients to minimize occupational transmission of HIV.     

Oral malignancies in HIV disease: changes in disease presentation, increasing understanding of molecular pathogenesis, and current management

Infection with human immunodeficiency virus (HIV) and progression to acquired immune deficiency syndrome (AIDS) are associated with a vide variety of morbidities. Local and systemic diseases can develop in association with HIV infection and may manifest themselves as malignancies of the oropharynx. Advances in HIV management, fueled by increasing understanding of molecular pathogenesis, have resulted in marked changes in the prevalence of oral malignant disease. This paper discusses recent trends in the presentation and treatment of malignancies related to HIV and AIDS with an emphasis on malignancies seen in the oral cavity.     

Oral Hygiene and dental student's knowledge, attitude and behaviour in managing HIV/AIDS patients

Abstract:  The human immunodeficiency virus (AIDS) and the acquired immunodeficiency syndrome (AIDS) have profoundly affected every aspect of the public health sector. The possibility of HIV transmission in the oral health care setting is very rare. Nonetheless, the oral health care environment has become a helpful setting for early detection, as most lesions of HIV infection present orally during the first stages of the disease. Willingness to treat patients with HIV/AIDS appears to be related to knowledge of the disease process, its oral manifestations and modes of transmission, thus influencing health workers' attitudes and behaviour towards management of HIV/AIDS patients. This study assessed the level of management of HIV/AIDS patients amongst dental and oral hygiene students at the University of the Western Cape Dental faculty. Student's knowledge of HIV/AIDS, their behaviour and attitude in treating HIV/AIDS patients, the precautionary measures practiced and their perceptions of curriculum preparation on HIV/AIDS were assessed. Data were collected by means of a self- administered questionnaire. The results indicated that students' knowledge on HIV/AIDS generally increased as they progressed throughout their curriculum but their utilization of all barrier techniques for infection control and clinical protocol, lacked consistency and compliance. Given the fact that the possibility of transmission of HIV/AIDS does exist within the dental setting, it is important that supervisors reinforce universal precautions. Clinical application of these precautions has a direct impact on the spread of the disease.     

Oral candidiasis and human immunodeficiency virus infection

The association of oral candidiasis with the human immunodeficiency virus (HIV) infection has been known since the advent of the acquired immunodeficiency syndrome (AIDS) pandemic. Oral candidiasis is one of the earliest premonitory signs of HIV infection and its diagnosis may have grave prognostic implications for the eventual development of full blown AIDS. There is now an expanding body of data on novel clinical variants of this 'old' disease, its epidemiology in HIV seropositive individuals and, advances in its management, particularly with respect to the recently introduced bis-triazole antifungals. Current concepts pertaining to the epidemiology, clinical features, pathogenesis, laboratory diagnosis and management of oral candidiasis in HIV infection are reviewed.