Neoplastic disease in the head and neck of patients with AIDS.

Immunosuppression increases the risk of developing malignancies. In immunosuppression due to human immunodeficiency virus (HIV) disease the common head and neck tumors are Kaposi's sarcoma and non-Hodgkin's lymphoma. Squamous cell carcinoma has also been reported. Kaposi's sarcoma is the commonest neoplastic disease in AIDS. The incidence of lymphoma is rapidly increasing. This article reviews the incidence, clinical presentation and management of these diseases in the head and neck in AIDS patients.     

HIV infection: clinical features and treatment of thirty-three homosexual men with Kaposi's sarcoma.

The clinical findings of patients with oral Kaposi's sarcoma are reviewed. These oral findings commonly included candidiasis, hairy leukoplakia, gingivitis associated with human immunodeficiency virus (HIV), periodontitis, and other symptoms, including xerostomia. The other common symptoms of HIV disease that may be of importance in leading to a diagnosis are reviewed in this patient group. Treatment by local radiotherapy or by intralesional vinblastine of these oral Kaposi's sarcomas resulted in successful palliation, with more than 50% regression of the lesions in 80% of the patients treated.     

Oral manifestations of HIV infection and their management. I. More common lesions

Oral lesions are common at all stages of HIV infection. This first of two articles reviews the clinical features and pathogenesis of common oral manifestations of HIV disease (candidiasis, hairy leukoplakia, Kaposi's sarcoma, and HIV-related periodontal disease) and considers current treatment measures.     

Oral manifestations of AIDS: an overview

Infection with the human immunodeficiency virus (HIV) may cause a variety of oral lesions, such as candidiasis, periodontal disease, hairy leukoplakia, Kaposi's sarcoma and a number of miscellaneous lesions and conditions. One hundred HIV-infected patients, including AIDS patients, referred to a University Hospital in Amsterdam, were examined orally. Most patients were initially seen by the Department of Internal Medicine, the oral examination by a well-trained dentist being part of the routine screening of all HIV-infected patients. In 80 per cent of all patients one or more HIV-related lesions of the oral mucosa was recorded. In 6 per cent of those patients the oral lesion was the first manifestation of the HIV infection. Hairy leukoplakia was observed in 15 per cent of all patients. Candidiasis proved to be the most common oral disease. In patients with full-blown AIDS the pseudomembranous form of candidiasis was the most common one, while in HIV-infected patients the erythematous type prevailed. These results emphasize the role of the dentist in making an early diagnosis of HIV infection.     

Oral Kaposi's sarcoma in a woman as a first indication of HIV infection

Although Kaposi's sarcoma has been well described in homosexual men at risk for infection with the human immunodeficiency virus, there have been fewer reports of KS in women, and most of these have been in women who became infected with HIV through intravenous drug use. This report describes a woman who had no history of intravenous drug use in whom intraoral KS and hairy leukoplakia were the first indication of her infection with HIV.     

Epithelioid angiomatosis affecting the oral cavity as a first sign of HIV infection.

Oral lesions are frequently the first manifestation of HIV infection and accurate diagnosis may be important in determining the management of individual patients. Lesions may be relatively common but non-specific, such as candidosis, or may be indicative of AIDS, such as Kaposi's sarcoma. Epithelioid angiomatosis is a recently described vascular lesion which may be clinically and histologically similar to Kaposi's sarcoma, but which is infective in origin. Usually it is a manifestation of AIDS and presents as multiple cutaneous lesions but has rarely been reported in the mouth. In this report a patient presented with lesions of epithelioid angiomatosis which were confined to the oral mucosa and which were associated with HIV infection, but not with AIDS. Differentiation from Kaposi's sarcoma is important, since epithelioid angiomatosis may be treated with antibiotics and a mistaken diagnosis of Kaposi's sarcoma may wrongly categorise an individual as having AIDS.     

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。     

Association of cutaneous and oral diseases in HIV-infected men

OBJECTIVES: Mucocutaneous diseases are common in patients infected with human immunodeficiency virus (HIV). To identify cutaneous diseases for which HIV-infected people are at high risk, we sought those that are strongly associated with specific HIV-related oral lesions and with progression of HIV disease.
DESIGN: A cross-sectional study of HIV-positive outpatients referred to a university stomatology clinic for diagnosis and treatment of oral diseases. Each subject underwent both complete oral and cutaneous examinations.
RESULTS: Among 55 men, with a median age of 41 years and a median CD4 cell count of 125/ju.l (range 0–950/pil), 93% had active oral diseases or conditions, including candidiasis, hairy leukoplakia, ulcers, Kaposi's sarcoma (KS), and xerostomia, and 95% had skin conditions, including onychomycosis, dermatophytosis, seborrheic dermatitis, KS, folliculitis, xerosis, and molluscum contagiosum. Seborrheic dermatitis, xerosis, skin KS, and molluscum contagiosum were associated with oral HIV-sentinel lesions (oral candidiasis, hairy leukoplakia, and KS), with low CD4 cell counts, and with AIDS.
CONCLUSION: Our results suggest that xerosis and seborrheic dermatitis may be early harbingers of HIV disease progression. Their roles as predictors warrant further study, based on their associations with low CD4 cell counts and AIDS and strong co-prevalence with one of the most common HIV-related oral lesions, oral candidiasis.     

Intraoral Kaposi's sarcoma: a correlated light microscopic, ultrastructural, and immunohistochemical study

Oral mucosal lesions of Kaposi's sarcoma are a common finding in patients with acquired immunodeficiency syndrome (AIDS). The histologic features of Kaposi's sarcoma vary, depending on the clinical stage of the lesion. Endothelium-lined vessels are the principal feature of early, macular lesions, while spindle cells dominate late-stage, nodular lesions. The histogenesis of both components remains controversial. In this study, biopsy specimens of intraoral Kaposi's sarcoma from 10 patients with AIDS were studied by light and electron microscopic examination and by immunoperoxidase staining with the endothelial markers, factor VIII-related antigen and Ulex europeaus agglutinin I. The results of this study support a vascular origin for both the endothelium-lined vessels and the spindle cells. The latter appear to represent vascular endothelial cells in various stages of differentiation. The histologic features that are useful in the diagnosis of intraoral Kaposi's sarcoma are reviewed.     

Oral Kaposi's sarcoma associated with acquired immunodeficiency syndrome among homosexual males

Clinical disease states encountered in the acquired immunodeficiency syndrome (AIDS) have been reviewed with an emphasis on oral Kaposi's sarcoma. The disease is reaching epidemic proportions among homosexual males and is characterized by onset of fever, malaise, diarrhea, and lymphadenopathy. Subsequent to these initial nonspecific signs and symptoms, patients develop a variety of opportunistic infections or Kaposi's sarcoma (or both). The oral lesions of Kaposi's sarcoma are characterized by red, blue, or purple plaques or nodules encountered primarily, yet not exclusively on the palate. Other oral manifestations of AIDS include candidiasis and herpetic stomatitis. Epidemiologic studies suggest the probability of a transmissible agent, perhaps a virus. It is recommended that dental care should be rendered to these patients, using mask and gloves with autoclave sterilization of all instruments.     

Gingival lesions of HIV infection in 178 Greek patients.

One hundred seventy-eight HIV-infected Greek patients were examined and the gingival lesions were recorded. At the time of oral examination, 77 patients were HIV positive, 53 had ARC, and 48 had AIDS. The mean age of the patients was 36.6 years; 158 were men and 20 were women. Fifteen different gingival lesions were recorded. Necrotizing gingivitis (10.1%), gingivitis (5.0%), periodontitis (18.5%), candidiasis (5.8%), and Kaposi's sarcoma (5.0%) were the most common lesions observed. Oral lymphomas and other lesions were recorded in low numbers. Our findings show that dentists should be aware of gingival lesions of HIV disease because some of them are common and diagnostically important.     

Human papillomavirus,type 40-associated papilloma,and concurrent Kaposi's sarcoma involving the anterior hard palate of an HIV-positive man

A number of oral lesions have been reported in association with HIV, including lesions caused by other viruses such as the epitheliotropic human papillomavirus (HPV). More than 90 types of HPV have been identified, with the less commonly encountered strains of HPV tending to show association with immunodeficiency states. In addition, HIV-infected patients may have Kaposi's sarcoma develop, a malignancy thought to be caused by human herpes virus, type 8. Recent evidence suggests a sexual mode of transmission for this virus. We report an HIV-positive man with a large, HPV type 40-associated papilloma of the anterior palate and a previously undiagnosed focus of Kaposi's sarcoma.     

A case series of acquired immunodeficiency syndrome patients with initial neoplastic diagnoses of intraoral Kaposi's sarcoma

BACKGROUND: Oral Kaposi's sarcoma (KS) may represent the initial clinical manifestation of immunosuppression in human immunodeficiency virus disease. This article reviews the treatment provided to these patients and the outcome of the disease and provides the opportunity to assess the impact of improvements in the medical therapy of acquired immunodeficiency syndrome on disease outcome. METHODS: A tumor registry was examined to identify patients in whom oral KS was the first neoplastic diagnosis. RESULTS AND CONCLUSIONS: Thirty-seven cases of oral KS representing 1.9% of all cases of KS were identified as the first malignant diagnosis in patients with acquired immunodeficiency syndrome. Patients with oral KS have limited survival; the cause of death is either infection or malignancy. In our study, the palate was the most common site of primary involvement in the oral cavity. Recently diagnosed patients remained alive longer than those diagnosed earlier, and the patients with the most recently diagnosed cases were alive at the completion of the study, suggesting that medical management of human immunodeficiency virus has improved with new therapies.     

Are the oral manifestations associated with HIV infection really relevant to the practising South African dentist? A comparative analysis of oral HIV studies in South Africa.

This comparative analytical review of oral HIV in South Africa, Africa and the West shows that relatively little work has been done on the African continent in this field of study. Direct epidemiological comparisons of these studies with each other are difficult but were made between these regions for overall prevalence values, mode of transmission and individual lesion presentation (candidiasis, oral hairy leukoplakia, periodontal disease, Kaposi's sarcoma, salivary gland disease, oral ulcers and other lesions). Apparent differences exist between the reported prevalence values of oral candidiasis, periodontal disease, Kaposi's sarcoma and tuberculous ulcers, the significance of which is uncertain. There is a need to standardise research methodologies. This would enable appropriate comparisons to be made and a better understanding of the implications of the oral HIV disease process in South Africa and elsewhere on the continent.     

HIV and dentistry. Part 4. Oral deviations in HIV infections: present classification and diagnostic criteria

In the present classification of oral lesions associated with HIV infection a distinction is made between presumptive and definitive diagnostic criteria. The former relate to the initial clinical appearance of the lesion and the latter are often the result of special investigations. Candidiasis, hairy leukoplakia, specific forms of periodontal disease, Kaposi's sarcoma and non-Hodgkin's lymphoma are strongly associated with HIV infection. Lesions less commonly associated with HIV infection and lesions seen in HIV infection, but not indicative of the disease, are also listed.     

Oral lesions in HIV infection in developing countries: an overview

HIV infection is a major global health problem affecting developing and developed countries alike. Oral lesions that are associated with this disease are important, since they affect the quality of life of the patient and are useful markers of disease progression and immunosuppression. Oral lesions in HIV infection have been well-documented in developed countries, but there are fewer reports on oral lesions from developing countries. Oral candidiasis is the most common opportunistic infection seen in all continents. Kaposi's sarcoma has been reported only from Africa and Latin America, while histoplasmosis and penicilliosis were reported in patients with advanced disease from Thailand. HIV-associated salivary gland disease has a high prevalence in Africa and Latin America, especially in the pediatric group. It is clear that there are considerable regional variations in the oral manifestations of HIV infection, depending both on the populations studied and on the clinical expertise available, among other factors. Well-designed and -documented studies are necessary for the correct assessment of the nature and magnitude of the problem in developing countries, if oral health measures are to be effectively formulated for the HIV-infected.     

Gingival Kaposi's Sarcoma: the first indication of HIV infection.

This article presents a case of gingival Kaposi's sarcoma that initially mimicked an acute periodontal infection, but was the first clinical sign of HIV infection in a 38-year-old male homosexual patient. The clinical features and treatment of oral Kaposi's sarcoma are discussed and the variable histopathology of the lesion is demonstrated.     

Kaposi's sarcoma of the parotid gland in acquired immunodeficiency syndrome

A patient with acquired immunodeficiency syndrome complained of a dry mouth and bilateral swelling of the parotid glands. Kaposi's sarcoma (KS) was found within the tissue of the parotid gland. Although KS is a common manifestation of acquired immunodeficiency syndrome, the presence of KS in the salivary glands is very rare. The human immunodeficiency virus I (HIV-I) genome was not identified in parotid glandular cells or in KS cells in this case, although the virus was detected in infiltrating lymphocytes and in tissue macrophages.     

Erythroplastic lesion on the mandibular marginal gingiva

Carcinoma of the gingiva is a significant risk to patients because the asymptomatic characteristics of erythroplastic lesions are not always readily identified. This case report shows the similarity in clinical appearance of squamous cell carcinoma of the gingiva to the common inflammatory changes associated with periodontal disease. A similar clinical presentation might be seen in any lesion with increased vascularity, including Kaposi's sarcoma associated with human immunodeficiency virus infection. Any erythroplastic change involving the oral mucosa should be viewed with suspicion and, if not resolved after removal of local sources of irritation, must be biopsied to establish a definitive diagnosis.