Mucous membrane manifestations of the acquired immunodeficiency syndrome

Since 1981, a syndrome of acquired immunodeficiency characterized by the development of severe, life-threatening opportunistic infections or unusual malignancies has evolved.^1–3 Acquired immunoeficiency syndrome (AIDS) is currently defined as the presence of a disease predictive of cellular immunodeficiency in patients with no known causes for diminished resistance to that disease.⁴ AIDS occurs primarily in homosexuals, intravenous drug abusers, hemophiliacs, and recipients of blood transfusions.⁵ At present, the weight of evidence points to the human T-cell lymphotropic virus (HTLV-III) as the etioogic agent of AIDS. This virus is capable of infecting and depleting lymphoid cells.⁵The laboratory and clinical abnormalities in patients with AIDS are protean. Common clinical manifestations of AIDS include fever of unknown origin, weight loss, and fatigue; diffuse pneumonia; diarrhea; and neurologic disorders and retinitis. Patients may exhibit marked immunologic abnormalities: anergy to skin-test antigens, lymphopenia, decreased lymphoproliferative response to mitogens, and a decreased T-lymphocyte helper-to-suppressor ratio. As a consequence, bizarre, more frequent opportunistic infections, more severe manifestations of more common types of infections, and the occurrence of unusual neoplasms have been described in these patients. These include pneumocystis, cryptosporidiosis, toxoplasmosis, candidiasis, cryptococcosis, and mycobacterial, cytomegalovirus, herpes simplex, and polyoma virus infections. Kaposi's sarcoma and undifferentiated lymphomas have also supervened in the setting of AIDS immunosuppression. In patients with AIDS, opportunistic infections or malignancies may involve almost every organ system.With a new-case rate of approximately two to three cases per day, a case fatality ratio of about 50%, and a Centers for Disease Control (CDC) estimation that between 1 and 2 million Americans may currently be HTLV-III antibody carriers, the individual and public health importance of AIDS need not be emphasized. Earlier diagnosis of AIDS or AIDS-related complex (ARC) may have profound individual and epidemiologic ramifications. The oral, anal, and genital mucosa are common initial sites of presentation for AIDS-associated diseases. In fact, mucosal disease may provide the first clue to the presence of underlying immunodeficiency. Although a number of the conditions affecting the mucosa of AIDS victims are covered elsewhere in this volume, it was felt that a separate chapter specifically devoted to reviewing the most common mucosal lesions associated with AIDS would be particularly useful to the clinician.