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。     

AIDS update. Oral manifestations and management

The acquired immunodeficiency syndrome (AIDS) pandemic continues to increase in magnitude and to plague the world. Dental professionals knowingly or unknowingly are involved in this pandemic because of the need to provide dental care without discrimination. Additionally, oral manifestations of human immunodeficiency virus (HIV) infection are common and often are major patient complaints as well as sometimes the first sign or symptom of HIV infection. Oral manifestations of HIV immunosuppression include opportunistic infections, autoimmune diseases, and malignancies. Therefore, the dental clinician has the opportunity to recognize and diagnose oral manifestations of HIV infection and to participate in patient management and counseling.     

Oral manifestations of viral infections in immunocompromised patients.

Viral infections are a significant cause of morbidity and mortality in immunosuppressed patients. It is clear that diseases or medical treatments that have cytostatic or cytotoxic effects on lymphocytes and disrupt cytokine production or activity increase the risk of viral infections. While the rate of viral infection varies with the nature and degree of immunosuppression, it is clear that reactivation of latent virus is the most important determinant of the types of viral infections most frequently noted in immunosuppressed patients result from the reactivation of latent virus. Herpesviruses account for the majority of oral viral infections. Herpes simplex virus, varicella-zoster virus, and Epstein-Barr virus infections nearly always result from reactivation of latent virus, while cytomegalovirus infections, besides presenting as reactivated disease, are almost as likely to present as a primary infection in susceptible hosts. Other viral pathogens potentially of concern in immunocompromised patients are enteric viruses (adenoviruses and coxsackieviruses), human papillomaviruses, and possibly the recently identified human herpesvirus type 6. Ninety-eight percent of herpes simplex virus lesions are caused by reactivated disease and tend to be characterized by large, very painful ulcerative lesions throughout the mouth. Varicella-zoster virus is also rarely seen as primary infection, and the herpes zoster lesions involving cranial nerves can cause significant morbidity, including postherpetic neuralgia, corneal scarring, cranial nerve palsies, and deafness. Distinct oral ulcerative lesions caused by Epstein-Barr virus and cytomegalovirus have only recently been described in detail and are usually associated with disseminated disease. Oral human papillomavirus lesions are noted as warts and condylomas. The contribution of enteric viruses and human herpesvirus type 6 to oral disease in immunosuppressed patients is yet to be determined.     

AIDS and the oral cavity

The oral cavity is the site for a number of diseases associated with an infection of the human immunodeficiency virus. Often the oral lesions may appear before the establishment of an AIDS diagnosis; and occasionally, the diagnosis may depend solely on the oral manifestations. The most commonly reported oral infections are those caused by Candida albicans and the herpes simplex virus. Hairy leukoplakia, a newly described lesion, may also be of viral origin. Kaposi's sarcoma is the most frequently reported oral malignancy in patients with AIDS. Oral squamous cell carcinoma and non-Hodgkin's lymphomas have also been reported.     

Recognition of oral lesions of HIV infection. 1. Candidosis

Oral problems are often the first significant clinical manifestations of infection with human immunodeficiency virus (HIV). Their early recognition affords the best opportunity for effective therapeutic intervention of HIV infection and opportunistic infections, as well as for oral health education in order to avoid future problems. This also provides optimal time for behaviour modification and coming to terms with the psychosocial consequences of HIV disease. This series of three articles presents a pictorial review and update on the oral manifestations of HIV infection.     

Primary syphilis of oral mucosa: case report of an unusual manifestation.

Dental clinicians and other health care providers have long been concerned about a variety of infectious agents that may be transmitted within the dental setting. Many infectious diseases, including human immunodeficiency virus, hepatitis, tuberculosis, and syphilis are important both because of their potential transmissibility and because the first manifestations of the disease may appear in the oral cavity. Oral disease as a consequence of primary syphilis is rare. This article details a patient presenting with a labial nodule as her only clinical manifestation of undiagnosed primary syphilis.     

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.     

Mechanisms of viral infections associated with HIV: workshop 2B

HIV infection is commonly associated with activation and dissemination of several other viral pathogens, including herpes simplex virus 1/2, human cytomegalovirus, human herpesvirus 8, Epstein-Barr virus, Varicella Zoster virus, and human papillomavirus, which behave as opportunistic agents and cause various diseases in immunocompromised hosts. The increased frequency and severity of diseases caused by these viruses in HIV-infected individuals is due mainly to dysfunction of both the adaptive and innate immune responses to viral pathogens. In addition, molecular interactions between HIV and these opportunistic viruses are likely to play critical roles in the progression of disease, including neoplasia. This report reviews the critical aspects of HIV interaction with opportunistic viruses, including Epstein-Barr virus, human cytomegalovirus, herpes simplex virus, Varicella Zoster virus, human herpesvirus 8, and human papillomavirus.     

Herpes simplex and hepatitis B infections and general practice

Recently there has been an increasing demand placed upon the dental profession to address the problem of viral disease transmission. Viral diseases currently of increasing concern to the medical and dental profession are those caused by the herpes simplex and hepatitis B viruses and the virus responsible for the acquired immunodeficiency syndrome (AIDS). The importance of these infections to the profession, and the management of patients who may be infectious, are placed in perspective.     

Human immunodeficiency virus infection: A review of the mode of infection, pathogenesis, disease course, and the general and clinical manifestations

Acquired immunodeficiency syndrome (AIDS) was first recognized in 1981 and in 1983 the virus responsible for this syndrome, the human immunodeficiency virus, was first isolated. There has been an increasing understanding of the many aspects related to infection with this virus and this review discusses the historical as well as the more recent findings related to infection with this virus. In particular, the pathogenesis, mode and course of infection are discussed followed by an overview of the general and oral manifestations of infection with this virus.     

Diagnosis and treatment of oral candidosis.

Oral candidosis is a common opportunistic infection that manifests in a variety of forms. It is also recognized as one of the earliest manifestations of human immunodeficiency virus (HIV) infection. Although a number of antifungal agents are available for the treatment of this condition, a newly introduced triazole group of drugs appears to be highly effective in treating oral candidosis. This article reviews the clinical presentation and management of oral candidosis, particularly with reference to the latter group of drugs and HIV-induced 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.     

Viruses in periodontal disease - a review

The purpose of this review was to evaluate the evidence supporting the hypothesis that viral infection plays a role in the development of periodontitis. An involvement in periodontal diseases has been suspected specifically for human immunodeficiency virus (HIV) and herpes viruses. An association has been demonstrated between HIV infection and some distinct forms of periodontal infection, i.e. necrotizing lesions. Furthermore, reports of increased prevalence and severity of chronic periodontitis in HIV-positive subjects suggests that HIV infection predispose to chronic periodontitis. Several studies, most of them from the same research group, have demonstrated an association of herpesviruses with periodontal disease. Viral DNA have been detected in gingival tissue, gingival cervicular fluid (GCF) and subgingival plaque from periodontaly diseased sites. In addition markers of herpesviral activation have been demonstrated in the GCF from periodontal lesions. Active human cytomegalovirus (HCMV) replication in periodontal sites may suggest that HCMV re-activation triggers periodontal disease activity. Concerns regarding sampling, methods and interpretation cast doubts on the role of viruses as causes of periodontal disease.     

Review of hepatitis non-A, non-B: the potential hazards in dental care

Several of the common viral agents that can cause hepatitis have been detected in body fluids, including saliva and blood, which may both form important routes for transmission of disease. The viruses most commonly implicated include hepatitis A virus (HAV), hepatitis B virus (HBV), cytomegalovirus (CMV), and Epstein-Barr virus. Hepatitis delta virus (HDV) can be found in persons positive for hepatitis B surface antigen (HBsAg) and presumably follows the same routes of transmission as HBV. Herpes simplex and echo viruses can cause hepatitis on rare occasion. Other agents, not yet positively identified but collectively referred to as non-A, non-B are also believed to follow the same routes as HBV and/or HAV. The aim of this reviews is twofold. First, we will discuss hepatotropic viruses other than HBV that may be spread via saliva and blood and, therefore, should be considered along with HBV as a potential health hazard to dental personnel and also to dental patients. The second aim is to highlight the epidemiology and the risk of transmission of these viral infections. The potential hazards are discussed in relation to those associated with HBV and human immunodeficiency viruses (HIV), implicated in the acquired immunodeficiency syndrome (AIDS).     

Emerging and changing viral diseases in the new millennium

Most viral infections encountered in resource‐rich countries are relatively trivial and transient with perhaps fever, malaise, myalgia, rash (exanthema) and sometimes mucosal manifestations (enanthema), including oral in some. However, the apparent benignity may be illusory as some viral infections have unexpected consequences – such as the oncogenicity of some herpesviruses and human papillomaviruses. Infections are transmitted from various human or animal vectors, especially by close proximity, and the increasing movements of peoples across the globe, mean that infections hitherto confined largely to the tropics now appear worldwide. Global warming also increases the range of movement of vectors such as mosquitoes. Thus recent decades have seen a most dramatic change with the emergence globally also of new viral infections – notably human immunodeficiency viruses (HIV) – and the appearance of some other dangerous and sometimes lethal infections formerly seen mainly in, and reported from, resource‐poor areas especially in parts of Asia, Latin America and Africa. This study offers a brief update of the most salient new aspects of the important viral infections, especially those with known orofacial manifestations or other implications for oral health care.     

Review of the herpesviruses and hepatitis A: the potential hazards in dental care

There is now an increased awareness of the risk of transmission of viral infections via blood and saliva after the publicity given to the human immunodeficiency viruses responsible for the acquired immunodeficiency syndrome. The herpesviruses have been found in blood, in blood products, and in saliva, and information with respect to these routes of transmission is convincing. Although hepatitis A virus is spread predominantly by water contaminated with feces (fecal-oral route), the virus is also found in saliva. On these grounds alone, these viruses must be considered a potential hazard in dentistry. Information in regard to the actual risks of their transmission in the context of dental practice is not yet available, primarily because a high proportion of infections are asymptomatic. Serologic studies of their prevalence suggest that all are widespread in the population. They are particularly common in many of the groups known to be at high risk for hepatitis B virus and human immunodeficiency virus, including promiscuous homosexuals, bisexuals, and intravenous drug abusers. In addition, pregnant women and their babies are particularly at risk from the herpesviruses. It is important to identify members of these high-risk groups as a potential source of transmission of infection through dental practice and in addition, it is important to identify them because they are prone to chronic sequelae.     

Herpetic gingivostomatitis in otherwise healthy adolescents and young adults

The purpose of this study was to review and analyze the records of herpes simplex infections from a specialist Oral Medicine clinic in Iceland, to investigate the clinical impression that the age of patients experiencing initial infection with this virus was higher than expected and that the character of the clinical picture of the disease had changed. Records of patients with herpes infections attending the Oral Medicine clinic covering a 3-year period were examined and the clinical and virological data analyzed. Diagnosis was based on clinical appearance, history, and viral identification with culture or detection of viral DNA by means of the polymerase chain reaction. Records of 60 patients (34 female) were included in the study (mean age, 23.1 years; range, 2 68 years). No patients were known or suspected to be positive for human immunodeficiency virus, none was known to be immunocompromised, and 38 patients (mean age, 16.6 years; 21 female) were diagnosed as having primary herpetic gingivostomatitis. Eighteen patients (mean age, 36.2 years; 11 female) had lesions of recurrent herpes simplex infection present on the oral mucosa. Primary infection with herpes simplex virus was more common in young adults than had been expected. Recurrent infections appeared on the oral mucosal even in otherwise healthy patients, and the clinical course of these infections in this age group sometimes followed a more severe course than that seen in young children.     

Oral infectious diseases: a potential risk factor for HIV virus recrudescence?

As the highly active antiretroviral therapy (HAART) has transitioned human immunodeficiency virus (HIV) infection into a 'chronic disease' management strategy, there is growing evidence that infection with non-HIV pathogens in HIV+ patients may have important public health implications in undermining HAART success and acquired immunodeficiency syndrome progression. Several bacterial and host cell products during infections with non-HIV pathogens have shown the capacity to regulate HIV replication in latently infected cells. A high prevalence of oral infections caused by bacteria, viruses and fungi has been described in HIV+ patients, including periodontal disease. The oral cavity appears to be a site of HIV pathogenesis and potential reservoir for the disease as HIV RNA and DNA forms are present in saliva as well as in gingival crevicular fluid, and oral epithelial cells are susceptible to either cell free or cell-associated HIV infection. The clinical and biological bases of potential associations between chronic oral inflammatory disorders, such as periodontal disease, and exacerbation of HIV viraemia have received little attention. This review attempts to evaluate the current understanding of HIV reactivation as a result of co-infection and/or inflammation induced by non-HIV pathogens in HIV-infected patients, and presents a hypothetic model about the potential role of periodontitis as a global oral infection that potentially contributes to HIV recrudescence.     

Oral hairy leukoplakia in three hemophiliacs with human immunodeficiency virus infection

Oral manifestations in AIDS, in AIDS-related complex, and in patients with antibodies to the AIDS-causing virus, human immunodeficiency virus (HIV), have been described previously. One of these manifestations, oral hairy leukoplakia, is apparently specifically associated with HIV infection and has until recently been reported in homosexual men only. This article demonstrates, among European patients, the occurrence of hairy leukoplakia in three patients belonging to another risk group for AIDS, namely HIV-infected hemophiliacs.