Ability of HIV/AIDS patients to self-diagnose oral opportunistic infections

OBJECTIVES: To assess the accuracy of HIV/AIDS patients' self-diagnosis of common HIV-related oral opportunistic infections. METHODS: 245 HIV/AIDS patients were interviewed regarding the current presence of oral candidiasis (OC), oral hairy leukoplakia (OHL), and oral ulcers prior to an oral examination by an oral medicine trained dentist examiner. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) are reported for the patient's oral lesion diagnosis compared to the dentist's diagnosis based on established presumptive clinical criteria as the gold standard. RESULTS: Self-diagnosis accuracy was greatest for pseudomembraneous OC (PPV 42.9%; NPV 93.5%), followed by oral ulcers (PPV 35.7%; NPV 98.3%) and OHL (PPV 23.5%; NPV 86.4%). Past experience with the lesion improved diagnostic accuracy, and bothersome symptoms accompanying the lesion had significant impact only for pseudomembraneous OC and oral ulcers. CONCLUSIONS: Moderate accuracy of patient self-assessment of oral lesions, with tendency to under rather than over report lesion presence, supports the use of patient self-assessment of these lesions to augment clinician diagnosis in clinical trials. Additionally, HIV/AIDS patients are unlikely to believe they have active OC that would lead to on-demand antifungal use, unless they have had prior experience with the lesion or it is at least moderately bothersome.     

What the dentist should know about a patient with HIV/AIDS

Chances are good that oral health care providers will treat someone with diagnosed or undiagnosed HIV during their careers. The Centers for Disease Control and Prevention estimate that 650,000 to 900,000 U.S. residents are living with HIV infection, more than 200,000 of whom are unaware of their infection. As with any medical condition, it is possible for a dentist to do great harm by ignoring systemic manifestations of HIV. On the other hand, dentists who are ignorant of modern HIV disease management often request unnecessary medical consultations resulting in dental treatment delays. Since 1996, the growing use of highly active anti-retroviral therapy and ultrasensitive viral load testing has changed the picture of the dental patient with HIV. The goal of this article is to update and summarize information the oral health care provider needs to safely treat a person with HIV/AIDS. It is not intended to replace previous comprehensive publications on HIV and dentistry, as they are still excellent resources for information. Here, simple instructions for physical evaluation of a patient with HIV/AIDS will be presented and steps for determining safe procedures explained.     

Youngsters with HIV/AIDS may be your patients

Advances in pharmaceutical "cocktails" are prolonging the lives of hundreds of thousands of US residents, including thousands of children who are infected with HIV/AIDS. The demographic characteristics of the increasing number of these children who are surviving and reside in communities were reviewed to alert pediatric dental practitioners to the reality that these children may be their patients.     

HIV／AIDS患者的白色念珠菌感染（附13例报道）

目的 研究白色念珠病在AIDS中的发病机制,有助于提高临床医师对该病的警惕性。方法 对13例HIV/AIDS患者进行系统体检,重点观察口腔病损情况,并行真菌培养。结果 全身症状主要为间断咳嗽、长期腹泻、低热、消瘦。3例发生严重的口腔白色念珠菌病,1例伴消化道白色念珠菌感染。结论 HIV感染导致免疫功能低下,易引起真菌、细菌、病毒等机会性感染,口腔白色念珠菌病常被认为是HIV感染的先兆症状,也易合并其它病损（二重感染）,对其早期发现,及时治疗,可防止感染向口咽、食道、胃等部位发展。     

Good ethical practice in the dental treatment of patients with HIV/AIDS

Patients with HIV/AIDS have challenged the ethics of the dental profession. The seriousness, infectious character and social stigma of the illness have led to a range of ethical dilemmas about the treatment of such patients. This paper attempts to resolve some of the more difficult questions through exploring the moral boundaries of the rights and duties of both patients and dental practitioners. To accomplish this aim, the moral foundation for the general clinical duties of care is outlined, especially the obligations of providing treatment to a high standard, respecting the rights of patients to informed consent and doing both without personal prejudice. After illustrating why these duties require moral character as well as intellectual understanding, their practical consequences are outlined for specific issues in the treatment of seropositive patients. It is argued that patients should never be tested without their informed consent and that dentists have a duty to display courage, sensitivity and rigorous respect for confidentiality in the treatments they offer. The obligations of seropositive dentists are also considered, including their own obligations for disclosure toward regulatory authorities and patients. The moral debt which the dental profession owes to seropositive patients is highlighted.     

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 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.     

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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。     

72例HIV/AIDS口腔病损的临床观察

目的：分析HIV感染者和AIDS患者常见口腔病损,以期提高临床医师对AIDS早期临床表现的认识,提高早期诊断准确性。方法：回顾分析72例HIV／AIDS患者临床症状、体征和实验室检查,分析口腔病损在AIDS早期诊断中的意义及与病程进展的关系。结果：常见口腔病变有：口腔白色念珠菌病、疱疹性口炎、非特异性口腔溃疡,其它病损如颌面部淋巴结炎、毛状白斑、卡波济肉瘤、带状疱疹、涎腺肿大,牙周病等,可单发或同时伴发。全身系统性疾病主要包括：肺炎、慢性腹泻、结核等。结论：AIDS患者发病前已开始出现明显口腔表现,其中以口腔白色念珠菌感染最为常见,对非法采供血、输血、静脉吸毒或不安全性行为等特殊人群,如出现难以治愈的”霉菌性口炎”或反复发作、原因不明的疱疹性口炎,或出现毛状白斑、卡波济肉瘤等口腔病变,应及时进行HIV检测。     

Periodontal disease in HIV/AIDS

Since the early 1990's, the death rate from AIDS among adults has declined in most developed countries, largely because of newer antiretroviral therapies and improved access to these therapies. In addition, from 2006 to 2011, the total number of new cases of HIV infection worldwide has declined somewhat and has remained relatively constant. Nevertheless, because of the large numbers of existing and new cases of HIV infection, the dental practitioner and other healthcare practitioners will still be required to treat oral and periodontal conditions unique to HIV/AIDS as well as conventional periodontal diseases in HIV-infected adults and children. The oral and periodontal conditions most closely associated with HIV infection include oral candidiasis, oral hairy leukoplakia, Kaposi's sarcoma, salivary gland diseases, oral warts, other oral viral infections, linear gingival erythema and necrotizing gingival and periodontal diseases. While the incidence and prevalence of these oral lesions and conditions appear to be declining, in part because of antiretroviral therapy, dental and healthcare practitioners will need to continue to diagnose and treat the more conventional periodontal diseases in these HIV-infected populations. Finding low-cost and easily accessible and acceptable diagnostic and treatment approaches for both the microbiological and the inflammatory aspects of periodontal diseases in these populations are of particular importance, as the systemic spread of the local microbiota and inflammatory products of periodontal diseases may have adverse effects on both the progression of HIV infection and the effectiveness of antiretroviral therapy approaches. Developing and assessing low-cost and accessible diagnostic and treatment approaches to periodontal diseases, particularly in developing countries, will require an internationally coordinated effort to design and conduct standardized clinical trials.