Patterns of oral manifestation of HIV/AIDS among 225 Nigerian patients

Objective:  The purpose of this study was to determine the prevalence of the oral manifestations of HIV/AIDS and to correlate the prevalence of these lesions with the stages of the disease in the Ife-Ijesa zone, Nigeria. No comprehensive data were available for correlating it with the staging of HIV/AIDS in this region.
Subjects:  The pattern of oral HIV lesions as classified by the EC-Clearinghouse was studied in 225 confirmed consecutive HIV-infected patients in this zone.
Methods:  Clinical dental examinations were conducted under natural daylight on all consenting HIV patients, sitting in an upright chair, using dental mirrors and probes.
Results:  The prevalence of oral HIV lesions was 84.0%, with lesions ranging in number from one to six. The commonest HIV lesion was pseudo-membranous candidiasis (43.1%) followed by erythematous candidiasis (28.9%), angular cheilitis (28.9%), linear gingival erythema (24.0%) and ulcerations (8.9%). Lesions less commonly found were oral hairy leukoplakia (1.3%) and salivary gland swellings (1.3%). Heterosexual intercourse was the most common mode of transmission (94.7%) and HIV-1 (96.9%) the most prevalent pathogen among the study population. The majority of the patients were in the WHO clinical stage III (59.1%) and presented late.
Conclusions:  The prevalence of oral HIV lesions in the present study was high.     

Oral manifestations among people living with HIV/AIDS in Tanzania

Background : This study aimed to determine the prevalence of various oral and peri‐oral manifestations in people living with HIV/AIDS in Tanzania. Methods : A cross sectional study. A total of 187 persons with HIV infection were recruited from non‐governmental organisations serving people living with HIV/AIDS, 16.6% were males and females 83.4%. Information on weight and height, as well as extra oral and intra oral examinations for different manifestations were gathered. Treatment and referral for special care were offered. Results : At least one oral lesion was present in 45% of the participants. Candidiasis (28.9%) and non‐tender lymphadenopathy (11.8%) were the most common lesions. Candidiasis occurred most frequently on lips/mucosa, and the tongue, and pseudomembranous candidiasis was the most frequent type. Candidiasis occurred with several other conditions and was statistically significantly associated with low body mass index (BMI). Conclusion : This community survey carried out in an African sub‐Saharan country showed that oral lesions are frequent among people living with HIV/AIDS. As emphasised by the World Health Organization Global Oral Health Programme, national HIV/AIDS programmes should incorporate oral health components.     

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。     

Oral lesions and conditions associated with human immunodeficiency virus infection in 300 south Indian patients

BACKGROUND: Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) is a major health problem in India. The National AIDS Control Organisation (NACO) of India reports a seropositivity of 25.03 per thousand for the whole country, as of October 1999. In spite of this high prevalence there are very few reports of oral lesions and conditions in Indian HIV/AIDS patients, which are important in early diagnosis and management of these patients. OBJECTIVE AND SETTING: The present report describes the oral lesions in 300 HIV positive symptomatic patients presenting to us at RAGAS-YRG CARE, a non-governmental organisation in Chennai, South India, over a period of 9 months in 1998. METHOD: Lesions were diagnosed on clinical appearance using international criteria. RESULTS: Of the 300 patients 89% had acquired the infection through heterosexual contact. There were 205 males and 95 females, aged from 7 months to 72 years. Forty-seven percent of the patients were in the age group 21-30 years. CD4 counts were ascertained for 105 patients, 64 (62%) had CD4 counts < or = 200. A total of 217 (72%) of the 300 patients had some oral lesion when examined. Gingivitis (47%) and pseudomembranous candidiasis (33%) were the most common oral lesions. The other oral lesions seen were oral mucosal pigmentation (23%), erythematous candidiasis (14%), periodontitis (9%), angular cheilitis (8%), oral ulcers (3%), oral hairy leukoplakia (3%), hyperplastic candidiasis (1%), oral submucous fibrosis (2%) and one case of leukoplakia. CONCLUSIONS: Oral lesions occur commonly in HIV infection. A comprehensive oral examination may not only suggest HIV disease but may also be useful in monitoring the disease progression. This is a cost-effective procedure, which may be useful in screening large populations in developing countries like India.     

Oral manifestations in HIV-positive adults from Northern Thailand

Eighty-seven HIV-infected patients in a provincial hospital in Northern Thailand were examined for oral manifestations of HIV disease and AIDS. The median age was 31.3 years. Seventy-four of the patients were women, 13 were men. 96.6% had a history of heterosexual transmission. Sixty-one patients were CDC-category A, 20 were category B and 6 were category C (AIDS). Thirty-eight percent of the patients revealed oral lesions; 23% had one oral lesion and 13.8% had two oral lesions. Common lesions were oral candidiasis (10.3% pseudomembranous candidiasis, 6.9% erythematous candidiasis and 3.4% both forms), oral hairy leukoplakia (11.5%) and exfoliative cheilitis (6.9%). Gingival linear erythema was seen in 8% of the patients; periodontal lesions and necrotising ulcerative gingivitis were not observed. Men were more commonly affected by oral manifestations than women (P < 0.004). The spectrum of oral lesions is comparable to other studies from the region, although most of these reported more men than women. Also, the degree of immunosuppression was more marked (AIDS).     

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.     

Oral signs and symptoms in 160 Greek HIV-infected patients

One hundred and sixty HIV-infected Greek patients were prospectively examined and the oral signs and symptoms were recorded. At the time of oral examination, 76 patients were asymptomatic seropositive, 47 were in ARC stage and 37 had AIDS. One or more oral findings were recorded in 90.6% of the patients while a total of 33 different lesions were observed. The more common oral lesions (highly suspicious) were candidiasis (61%), hairy leukoplakia (24%), periodontitis (19%), necrotizing gingivitis (11%) and Kaposi's sarcoma (12%). In addition some unclassified lesions or symptoms (xerostomia 26%, burning mouth syndrome 19%, patchy depapillated tongue 16%, hairy tongue 10%, exfoliative cheilitis 4%), were common while submandibular and cervical lymph node enlargement were found in 49% of the patients. Interestingly in 16 patients (10%) the suspicion of HIV infection was exclusively based on oral lesions. Our findings show that oral signs and symptoms are common and some times early manifestations of HIV infection and it is in association to those reported in previous studies.     

Oral manifestations in HIV/AIDS infected patients from India

OBJECTIVES: To assess types and prevalence of HIV-related oral lesions among HIV-infected individuals in south India and to correlate common oral findings with co-morbidities, gender, age and medication. SUBJECTS AND METHODS: One hundred and one patients with HIV infection or AIDS at infectious diseases units of Attavar Hospital, Mangalore, and medical wards of Kasturba Medical College, Manipal, were selected. Sociodemographic information was obtained using a structured questionnaire. Oral lesions were diagnosed according to the presumptive criteria of EEC-Clearinghouse Classification. Clinical history was retrieved from patient's medical records. RESULTS: Erythematous candidiasis (44.5%), melanotic hyperpigmentaion (34.6%) and xerostomia (29.7%) were among the most common oral manifestations. A significant association was found between oral candidiasis and advanced immunosuppression (P < 0.05). Oral hairy leukoplakia (OHL) was predominant in individuals <35 years (P < 0.05). Melanotic hyperpigmentation was significantly associated with highly active antiretroviral therapy (P < 0.05). OHL was more frequent in patients with HIV-associated tuberculosis. Linear gingival erythema was more predominant in females. CONCLUSIONS: Oral hairy leukoplakia showed a positive relationship with patients younger than 35 years. Oral candidiasis can act as a marker for immunosuppression. Angular cheilitis was predominant in the symptomatic stage.     

Dental and oral lesions in HIV infected patients: a study in Brazil

AIM: To determine the prevalence of dental and oral lesions, as well as treatment need, in a group of HIV sero-positive Brazilians. In addition, to test the association between oral manifestation of HIV infection and age, sex, mode of transmission and drug therapy. METHOD: All HIV seropositive patients attending a dedicated dental clinic in Recife were invited to participate in the study. They were all examined by one trained and calibrated examiner and interviewed by one trained interviewer. RESULTS: 161 of 204 patients (78.9%) agreed to participate in this study. Most of the participants were male (76%), had acquired HIV sexually (74.5%), and were taking some form of antiretroviral therapy (70.8%). 33.5% had one or more oral manifestation of HIV. Candidiasis was the most common (28.6%), followed by hairy leukoplakia (9.3%), Kaposi sarcoma (2.5%), ulceration (2.5%), herpes simplex (1.2%), papiloma (0.6%), and 4.4% had periodontal disease. Only 1.2% reported xerostomia. There were no differences in the prevalence of oral manifestations of HIV infection between age groups, sexes, modes of transmission and types of drug therapy (P>0.05). The mean DMF-T score was 19 (SD 8) and 78.9% needed some form of dental treatment. CONCLUSIONS: While the prevalence of oral manifestations of HIV/AIDS was low in this sample of HIV seropositive Brazilians, dental status was poor and need for dental treatment was high.     

Changes in the prevalence of HIV-associated mucosal disease at a dedicated clinic over 7 years

OBJECTIVE: To investigate changes in the prevalence of mucosal disease in patients with HIV/AIDS. DESIGN: Retrospective analysis of clinic database. SETTING: An open-access dental clinic dedicated to the dental treatment of patients infected with HIV in London, UK. SUBJECTS: Dental patients attending for routine assessment (check-up). MAIN OUTCOME MEASURES: Prevalence of HIV associated oral lesions, diagnosed in accordance with EC classification criteria, in patients taking and not taking antiretroviral therapies (ARTs). RESULTS: Data were collected at 2789 dental examinations for 1590 patients between 1992 and 1998. More patients taking ART had one or more oral manifestations in the years up to 1996, after which the prevalence fell to a similar level to those not taking medications. The prevalence of mucosal disease in patients not taking ART was relatively constant over time. These trends were observed for oral hairy leukoplakia, pseudomembranous and erythematous candidiasis and Kaposi's sarcoma but not for oral papillomata. CONCLUSIONS: These data provide evidence that decreases in the prevalence of oral disease in people with HIV infection can be attributed to the effectiveness of ART.     

A randomized clinical trial of chlorhexidine in the maintenance of oral candidiasis-free period in HIV infection

Objective: To determine if chlorhexidine can be used as an intervention to prolong the time to relapse of oral candidiasis. Subjects and methods: A double‐blinded randomized clinical trial was performed in 75 HIV/AIDS subjects with oral candidiasis. Clotrimazole troche was prescribed, and the subjects were re‐examined every 2 weeks until the lesions were completely eradicated. The subjects were then randomly divided into two groups; 0.12% chlorhexidine (n = 37, aged 22–52 years, mean 34 years) and 0.9% normal saline (n = 38, aged 22–55 years, mean 38 years). They were re‐examined every 2 weeks until the next episode was observed. Results: The time to recurrence of oral candidiasis between the chlorhexidine and the saline group was not statistically significant (P > 0.05). The following variables were significantly associated with the time of recurrence; frequency of antifungal therapy (P = 0.011), total lymphocyte (P = 0.017), alcohol consumption (P = 0.043), and candidiasis on gingiva (P = 0.048). The subjects with lower lymphocyte showed shorter oral candidiasis‐free periods (P = 0.034). Conclusions: Chlorhexidine showed a small but not statistically significant effect in maintenance of oral candidiasis‐free period. This lack of significance may be due to the small sample size. Further study should be performed to better assess the size of the effect, or to confirm our findings.     

Prevalence of oral mucosal lesions in adults undergoing highly active antiretroviral therapy in Hong Kong

Aim:  Highly active antiretroviral therapy (HAART) has altered the prevalence and incidence of oral mucosal lesions of HIV infection. Recent reports show a variation in the prevalence of oral mucosal lesions in different population groups. Understanding the prevalence of these lesions is of paramount importance in the efficient delivery of dental care to such cohorts. The aim of the present study was to investigate the prevalence of oral mucosal lesions and salivary parameters during HAART in an ethnic Chinese cohort in Hong Kong. Methods: A cross‐sectional estimation of the prevalence of oral mucosal lesions was carried out in 101 HIV‐infected ethnic Chinese in Hong Kong using the European Community–Clearinghouse classification. Results: The prevalence of oral mucosal lesions was more common in patients who were classified at baseline as Centers for Disease Control (CDC) C3 category than CDC A2, A3, B2, and B3 (P < 0.05). An overall prevalence of 1.98% was observed for oral Kaposi’s sarcoma. Additionally, the HIV group on HAART (0.37 ± 0.23 mL/min) had significantly lower salivary flow rates (P < 0.01) compared with the healthy group (0.49 ± 0.15 mL/min). Conclusions: Although HAART appears to markedly reduce the prevalence of oral mucosal lesions during the course of HIV disease, regular systematic oral screening is still warranted for such populations for the early diagnosis and management of pathologies, such as Kaposi’s sarcoma.     

Oral manifestations associated with human immunodeficiency virus infection in a Spanish population

A study was made of the oral manifestations in 396 patients with human immunodeficiency virus (HIV) infection. The following risk groups were established: intravenous drug users (79.5%), homosexuals (7.8%), homosexual intravenous drug users (3.3%). heterosexuals (8.1%) and hemophiliacs/transfusion patients (1.3%). The oral lesions, in decreasing order of frequency, were: periodontal disease (78.28%). candidiasis (65.65%). hairy leukoplakia (16.16%). herpes simplex virus lesions (5.30%), Kaposi's sarcoma (2.27%), recurrent aphthous ulceration (RAS) (1.01%), lichen planus (0.5%), non-Hodgkin's lymphoma (0.25%). tuberculous lesion of the tongue (0.25%) and ulcerations of uncertain etiology (0.25%). Attention is drawn to the greater predominance of these lesions in patients with CD4 values of less than 200/mm³, compared with those who have higher lymphocyte counts.     

Sentinels and signposts: The epidemiology and significance of the oral manifestations of HIV disease

A large number of studies attest to the frequency of oral disease in those with HIV infection. Most show that hairy leukoplakia and pseudomembranous candidiasis are the commonest lesions in those with HIV infection and AIDS, with higher prevalence and incidence rates correlating with falling CD4 counts and disease progression. HIV-infected individuals with oral candidiasis or hairy leukoplakia progress to AIDS more rapidly than matched controls without these lesions. Oral candidiasis and hairy leukoplakia increase with time since seroconversion. On the other hand, parotid enlargement in children appears to be associated with slower progression to AIDS. As a consequence of these and other observations, oral lesions are widely included in natural history studies, staging and classification schemes for HIV infection. In addition to their role in the diagnosis of HIV infection and as indicators of the progression of HIV disease, oral lesions are used as clinical correlates of CD4 counts and as criteria for entry into clinical trials.     

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。     

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.     

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 manifestations in 101 Cambodians with HIV and AIDS.

BACKGROUND: The HIV/AIDS epidemic in Cambodia has become a major problem in the last 7-8 years, mainly because in this formerly war-stricken country the socioeconomic situation is only slowly improving. Since only very few studies have been published to date on the oral health status of Cambodian HIV/AIDS patients, it was the purpose of the present investigation to study oral manifestations in Cambodian patients with HIV disease. METHODS: One hundred one Cambodian patients with HIV infection or AIDS were examined for the presence of oral manifestations in one medical center in Phomh Penh, Cambodia. RESULTS: Sixty-three men and 38 women with a median age of 32 years were examined (age range 7.5-63.5 years). Of these patients, 42.6% were smokers, 46.5% of men were heavy drinkers and 90.5% of men were promiscuous compared with 5.3% of women. The most frequent AIDS-defining diseases were wasting syndrome (54.5%), Pneumocystis carinii pneumonia (PcP) (19.8%) and tuberculosis (18.8%). Puritic papular eruption, a common cutaneous manifestation in HIV-infected patients, was seen in 17.8% of patients. Candida-associated infections of the oral cavity were most common. Among the patients, 52.5% revealed pseudomembranous candidiasis and 35.6% had bilateral hairy leukoplakia. Only 10% of patients had no oral lesions. Also common were necrotising ulcerative gingivo-periodontal diseases (27.7%). CONCLUSION: The general health status of 101 Cambodian patients with HIV infection and AIDS was poor, and they demonstrated a large number of oral manifestations. Antiretroviral therapy is presently not available and only a fraction of patients receives antimycotic treatment (25.7%). HIV infection and the AIDS epidemic in Cambodia have become a serious problem and patients urgently need adequate diagnosis and antiretroviral therapies.