Oral candidiasis and hairy leukoplakia correlate with HIV infection in Tanzania

We report a detailed study on oral lesions and their association with the WHO revised provisional case definition of AIDS as well as serologic signs of HIV infection among 186 patients in Dar Es Salaam, Tanzania. The patient material consisted of 39 hospitalized suspected AIDS patients, 44 medical nonsuspected patients, 53 dental outpatients, and 50 patients with sexually transmitted diseases. The male:female ratio was 2.1:1 on average. Oral examination was done without knowledge of the HIV status of the patients. Among 39 suspected AIDS patients 97% had WHO AIDS criteria and 90% were seropositive for HIV. Among the 147 patients not suspected of having AIDS 18 (12%) had AIDS criteria and 15% had serologic evidence of HIV infection. The presence of WHO AIDS criteria correlated significantly with the presence of HIV antibodies, but not with HIV antigen. Oral lesions were found in 54% of those with AIDS criteria and 52% of HIV-infected patients, as compared to 3% and 6% of the patients without AIDS criteria and HIV infection, respectively (p less than 0.01). Among patients with AIDS atrophic candidiasis occurred in 21%, pseudomembranous candidiasis in 23%, hairy leukoplakia in 36%, herpetic stomatitis in 2%, Kaposi's sarcoma in 4%, and nonspecific ulcer in 4%. The presence of oral lesions had a high predictive value for presence of AIDS criteria as well as for presence of HIV infection in this hospital setting. All patients should have a thorough oral examination and the presence of the aforementioned oral lesions should lead to testing for HIV infection.     

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.     

The prevalence of AIDS-associated oral lesions in a cohort of patients with hemophilia

Oral and perioral lesions have been widely reported in homosexual males and intravenous drug abusers who are seropositive for the human immunodeficiency virus (HIV) or have acquired immunodeficiency syndrome (AIDS). Several case reports have also noted some AIDS-associated lesions among persons with hemophilia, but the prevalence of these lesions in hemophilia populations is not known. This study investigated the prevalence of oral and perioral lesions in a cohort of patients receiving care at a hemophilia treatment center. In a sample of 32 patients with a factor VIII deficiency and 5 patients with a factor IX deficiency who underwent oral examinations, more than 80% were HIV seropositive. Cervical lymphadenopathy was present in more than half of the patients who were HIV seropositive but was absent in those who were HIV seronegative. Intraoral AIDS-associated lesions were present only in patients for whom a diagnosis of AIDS had been made, indicating that oral lesions among persons with hemophilia who are HIV seropositive may be less prevalent than among homosexual males or intravenous drug abusers who are HIV seropositive.     

Oro-facial lesions and CD4 counts associated with HIV/AIDS in an adult population in Oyo State, Nigeria

OBJECTIVE: The objective of this study was to define the oro-facial lesions associated with Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) in an adult population in Oyo state, Nigeria and to relate these with the level of immune suppression as measured by the CD4 counts. MATERIALS AND METHOD: The study population consisted of 679 consecutive subjects who were seen at the state-owned blood bank. Information on demography, medical and medication histories were obtained. Oro-facial examinations were carried out according to Greenspan et al [Oral Surg Oral Med Oral Pathol (1992)73:142-144]. HIV sero-prevalence status was determined for all patients. CD4+ T-lymphocyte count was carried out for those sero-positive for HIV and 31 randomly selected HIV-negative subjects. Data were analyzed using the chi-square test, Fisher's exact test, Student's t-test and odds ratio where appropriate. RESULTS: Eighty-one (11.9%) of the entire study sample were confirmed HIV positive. The prevalence of specific oral lesions by HIV sero-status revealed that pseudomembranous oral candidiasis and angular cheilitis occurred significantly and more frequently in HIV-positive subjects (33.3 and 21% respectively) than those who were HIV negative (4.3 and 1.8% respectively, P < 0.05). The mean CD4 count of the HIV-positive subjects was 452 cells mm(-3), s.d. 137, while it was 602 cells mm(-3), s.d. 251, for the HIV negatives. The difference was statistically significant (P = 0.000). Forty-four (66.7%) subjects with CD4 counts <500 cells mm(-3) had oro-facial lesions whereas among those with CD4 counts >500 cells mm(-3) only 22 (33.3%) had oro-facial lesions (OR = 4.57). CONCLUSION: The type of oro-facial lesions most commonly associated with HIV/AIDS in Oyo state, Nigeria, has been shown to be pseudomembranous oral candidiasis. This was followed by angular cheilitis. These lesions, although found in HIV-negative subjects, were in a lower proportion as compared with HIV-positive subjects. Mean CD4 counts were lower in HIV-positive subjects and this was associated with greater prevalence of oro-facial candidiasis and angular cheilitis.     

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.     

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 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.     

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。     

Prognostic value of oral candidosis and hairy leukoplakia in 111 Mexican HIV-infected patients

A follow-up study was carried out to evaluate the prognostic value of hairy leukoplakia (HL) and oral candidosis (OC) in a cohort of 111 asymptomatic Mexican HIV infected patients. Oral exams were performed at baseline and every 6 months, from September 1989 to March 1994. Chi-square contingency table test, the Kruskall-Wallis one-way analysis of variance, the Kaplan-Meier product-limit method and the log rank test were used for the analysis. Univariate and multivariate Cox's proportional hazards analysis were also performed. Fifty-four patients (51%) progressed to AIDS (initially 36 CDC-II and 18 CDC-III). Individuals with HL and/or OC, showed faster development to AIDS than subjects without lesions or other HIV-related manifestations (P=0.008). The presence of OC, HL or both always remained significant despite adjustment for total lymphocytes, CDC stage, zidovudine therapy or its combinations. Oral lesions in HIV infection may be regarded with other clinical and laboratory studies as markers of HIV disease progression and as indicators to begin antiretroviral treatment.     

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.     

Group II and III lesions in HIV positive Nigerians attending the General Hospital Lagos, Nigeria.

OBJECTIVE: To document the prevalence of Group II and Ill oral lesions of HIV in adult seropositive Nigerians. STUDY DESIGN: A longitudinal study of 100 HIV infected adult Nigerian patients attending the HIV Clinic of the General Hospital, Lagos, Nigeria. STUDY PERIOD: January 2001 to October 2002. METHOD: Oral lesions were diagnosed based on documented diagnostic criteria by GREENSPAN et al, for oral manifestation of HIV. WHO classification of oral lesions based on the degree of association with HIV infection was also used. Oral lesions were treated using established treatment protocols. RESULTS: Seventy patients had oral lesions of HIV, of these fourteen (20%) patients had Group II and III oral lesions of HIV infection: Five (7%) patients had recurrent aphthous ulcers (RAU), 4 (6%) had herpes zoster of the trigeminal nerve. Majority of patients presented with oral symptoms severe enough to require use of appropriate medication. Recurrence of oral lesions occurred in all cases of RAU seen. CONCLUSION: Group II and III lesions are less prevalent than group I lesions in HIV infected adult Nigerians. They may be the presenting oral lesions of HIV/AIDS. These oral lesions of HIV are associated with a lot of pain, morbidity and may also compromise aesthetics. By compromising adequate nutrition and practice of good oral hygiene, they may lead to further deterioration of the health of the patient and can accelerate the course of the disease. Early recognition and diagnosis of these lesions by the oral clinician and/or trained dental practitioner affords the patient the opportunity of receiving prompt and appropriate medical treatment as well as counseling.     

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.     

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 manifestations of HIV infection in 600 South African patients

Arendorf TM, Bredekamp B, Cloete CAC, Sauer G: Oral manifestations of HIV infection in 600 South African patients. J Oral Pathol Med 1998; 27: 176-9. C Munksgaard, 1998. Oral lesions associated with HIV infection, as classified by the EC-Clearinghouse on Oral Problems related to HIV infection and the WHO Collaborating Centre on Oral manifestations of the immunodeficiency virus, were studied in 600 consecutive HIV-infected patients in Cape Town, South Africa. One or more lesions were seen in 60.4% of cases. Combined candidal lesions were evident in 37.8%, hairy leukoplakia in 19.7% and combined gingival/periodontal lesions in 8.5% of patients seen. Lesions less commonly recorded include oral ulceration (2.9%) and Kaposi's sarcoma (1.5%). The clinical range of lesions seen is similar to those reported elsewhere, but socio-cultural differences allowed no reliable comparison. More than a quarter of our patients had oral soft tissue discomfort necessitating treatment; in 3.3% these were the presenting symptom. This indicates a potential major public health concern requiring education in recognition and appropriate referral and management.     

Oral manifestations of HIV infection in 36 Nigerian children

Oral manifestations of HIV/AIDS are early and common clinical indicators of HIV infection. There has been no report on the clinical prevalence of oral lesions associated with HIV infection in children in sub-Saharan Africa. We report the findings of a cross sectional study of 36 Nigerian children seen at the Pediatrics Infectious Disease Clinic of the AIDS Prevention Initiative in Nigeria (APIN), Jos University Teaching Hospital (JUTH) Jos, Nigeria.     

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 research and dental treatment in HIV infection.

In June 1991, practicing, research, and academic dentists attended a symposium on oral research and dental treatment in HIV infection at Guy's Hospital in London, England. Oral lesions in HIV infection were classified as strongly associated, probably associated, and possibly associated with HIV infection. A speaker stressed that those strongly associated with HIV infection should be of the most interest to general dental practitioners. Another speaker said that chronic erythematous candidiasis has emerged as an oral infection strongly associated with HIV infection in addition to pseudomembranous candidiasis. A dentist mentioned hairy leukoplakia as a new condition strongly associated with HIV infection. Other HIV associated periodontal disease included gingivitis, necrotizing gingivitis, and periodontitis. A speaker noted that AZT increases longevity of AIDS patients and the drugs dideoxyinosine and dideooxycytidine are being tested. Another dentist spoke about the issue of HIV infected dentists citing the example of the dentist in Florida who infected 5 patients. Other speakers addressed the cases and needs of asymptomatic HIV infected people. A survey of dentists showed that only 33% of dentists would provide dental care to HIV infected people and only 20% would if the patients had AIDS. A dentist addressed the problem of a lack of data on prevention and treatment of oral lesions since their etiology and pathogenesis were unknown. Other presentations focused on research on antibodies and DNA probes in reference to saliva and subgingival flora. The symposium revealed the ran ge and depth of research going on in British schools on oral manifestations of HIV infection.     

Oral HIV‐associated Kaposi sarcoma

J Oral Pathol Med (2012) Kaposi sarcoma (KS), an AIDS defining condition, remains one of the most commonly HIV‐associated neoplasms. While the use of highly active antiretroviral therapy (HAART) has brought about a dramatic decrease in the prevalence and incidence of AIDS‐KS worldwide, this has not been the case in resource‐poor sub‐Saharan African countries, where HIV has reached epidemic proportions and human herpesvirus‐8 infection is endemic. Oral involvement is a common manifestation of AIDS‐associated KS and may be an early presenting finding of HIV infection. The clinical manifestation of oral KS can vary and may have an unpredictable course ranging from mild to fulminant. Rapidly progressive facial lymphoedema associated with extensive advanced oral KS portends a poor prognosis. Oral KS may regress with antiretroviral therapy or may flare up as part of the immune reconstitution inflammatory syndrome. The oral lesions of AIDS‐KS are best managed with HAART together with systemic chemotherapy. This article provides a review of contemporary knowledge of the biology, pathology, clinical features and management of oral AIDS‐KS.     

Oral manifestations in 45 HIV-positive children from Northern Thailand

Forty-five Northern Thai children with HIV infection or AIDS were examined for oral manifestations. Of these children, 51.1% (n=23) were asymptomatic (category N), 48.9% were mildly, moderately or severely symptomatic (category A, B, C) and 48.9% (n=22) revealed oral lesions. Eleven patients (24.4%) showed one oral lesion, eight (17.8%) had two and three (6.6%) had three oral lesions. Erythematous candidiasis was the most common lesion (17.8%). Oral hairy leukoplakia was seen in 6.7% (n=3). Geographic tongue, not usually considered to be associated with HIV infection, was seen in 6.7% (n=3). Only 15 patients (33.3%) received antiretroviral therapy (ART). Comparison of patients with or without ART did not show differences in the prevalence of oral lesions. More studies in Thai HIV-infected children are needed to reveal the prevalence of oral manifestations, as well as for the predictive value of the most common or specific oral manifestations.