5. Viral Infections 1 Flashcards
What is the immunopathogenesis during the early acute phase HIV infection?
Self limiting illness within weeks (immunocompetent)
High levels of virus production, viremia and reduction of CD4+ T cells
Seroconversion: production of anti-HIV ABs (used for clinical screening for HIV infection)
at end, CD4 numbers return to normal
What is the immunopathogenesis during the middle clinical latent period of HIV infection?
Stage relative containment of the virus
continue HIV replication at low levels
continue CD4 cell loss
asymptomatic , some may have persistent lymphadenopathy and minor opportunistic infections
What is the immunopathogenesis during the final crisis phase of HIV infection?
Break down of host defensive system
Profound loss of CD4+ cells
full blown AIDS
How is HIV transmitted?
Sexual
Parenteral
Mother to infant
Body fluids such as semen and blood are usually source of infection
Saliva of HIV pts contain virus but transmission via saliva is rare
What are the EC-Clearinghouse Classifications of oral manifestations of HIV disease in adults?
Group 1: oral and maxillofacial lesions strongly associated with HIV infection
Group 2: less commonly associated with HIV infection
Group 3: seen in HIV infection
Group 1 manifestations are rare outsideo f HIV setting
Group 2 and 3 can be seen with HIV pts but also non-HIV pts
What are the group 1 HIV oral manifestations?
Candidiasis
Oral hairy leukoplakia
Kaposi’s sarcoma
Non-hodgkin’s lymphoma
Periodontal dz
What is the most common intraoral manifestation of HIV infection?
oral candidiasis
most common agent of oral candidiasis?
Candida albicans
What is an inidication of a patient’s immunosuppression when sen with oral candidiasis?
low CD4
how to lower oral candidiasis frequency in HIV pt?
HAART
What is the most common EBV related lesion in HIV pts?
Oral hairy luekoplakia
S/S of Orla hairy leukoplakia?
Faint or thickened white vertical streaks that do not rub off usually on lateral tongue
histopathology of oral hairy leukoplakia?
Hyperkeratosis and layer of balloon cells in upper spinous layer
Detect EBV by immunohistochemistry or insitu hybridization
Oral hairy leukoplakia Tx
Not needed
What is kaposi’s sarcoma?
Systemic malignant vascular tumor caused by HHV-8/KSHV
Kaposi’s sarcoma appearance?
Red to purple skin or mucosal lesions with or without internal involvement
What are the 4 subtypes of kaposi’s sarcoma?
Classic subtype: Western world
African endemic subtype: Sub-saharan Africa
Latrogenically immunosuppressed subtype: transplant pts
Epidemic AIDS related subtype
Kaposi’s sarcoma classic subtype S/S
middle-aged and elderly men of Mediterranean or European descent
Relatively indolent
Affects lower extremities but stays on skin. does not spread internally
Laposi’s sarcoma African endemic subtype S/S
Mostly young patients (<40)
begin in lower extremities but expand ot other areas
Kaposi’s sarcoma AIDs related subtype S/S
Agressive
spreads to various parts of the body including internal organs
What is the most common malignancy in HIV pts?
Kaposi’s sarcoma
how does HIV associated Kaposi’s sarcoma manifest?
multiple lesions of the skin, oral mucosa and viscera
How does HIV related kaposi’s sarcoma appear in the mouth?
Start as purple macular lesions and later develops into nodules
invade bone
affects palate (most common), tongue and gingiva
Dx of oral HIV related Kaposi’s sarcoma
Biopsy is necessary
Will see vascular proliferation
Presence of HHV8
What is the second most common malignancy in HIV?
Non-hodgkin’s lymphoma
Pathogen involved in NHL?
EBV
S/S of HIV associated NHL
Extranodal lymphoma esp in the CNS
OUtside of HIV pts, NHK will not be involved in extranodal sites
What are the 3 paterns of HIV associated periodontal dz?
Linear gingival erythema
- band of erythema involving free gingival margin
Necrotizing ulcerative ginigivitis/mucositis
- Ulceration/necrosis of one or more interdental papillae without loss of periodontal attachment
- only gingiva or surrounding soft tissue is involved
Necrotizing ulcerative periodontitis
- gingival ulceration/necrosis associated with rapid progressive loss of periodontal attachment
- multiple isolated defects often are seen in contrast with the diffuse pattern associated with typical chronic periodontitis
What is HIV associated salivary gland dz?
Salivary gland enlargement associated with HIV
Which salivary gland is most commonly involved in HIV associated salivary gland dz?
Parotid gland
Common result = xerostomia
How does diffuse infiltrative lymphocytosis syndrome cause hiv associated salivary gland dz?
Persistent circulating CD8+ lymphocytosis (to fight virus) is accompanied by lymphocytic infiltration in various organs
salivary gland = most common organ involved in infiltration
Syndrome is associated with high risk of B cell lymphoma - pts need to be monitored
What are common perioral manifestations of HPV infection?
Verruca vulgaris (common wart)
Oral squamous papilloma (cauliflower appearance)
How do perioral manifestations of HPV infectoin in HIV pts differ from non HIV pts?
cluster of nodules (multiple exophytic papillary nodules)
Unusual variants of HPV (type of HPV present in lesion is different from non HIV pts–HPV strains that dont normally cause lesions)
How does HAART affect HPV infectoin lesions?
Increased prevalence of lesions
How do aphthous ulcerations differ in HIV pts vs non HIV pts?
Increased frequency to develop all forms of apthous ulcer
Unlike normla pts, most HIV pts develop major or herpetiform ulcers which are abnormal for normal pts ulcer on all tissue not just nonkeratinized
What is molluscum contagiosum?
Infection of the skin caused by poxvirus
How does molluscum contagiosum affect immunocompetent pts?
Children
Small dome shaped papules with a central depression center
self limiting
How does molluscum contagiosum affect HIV pts?
Hundreds of lesions occasionally obtaining large size
Little tendency to undergo spontaneous resolution
How does HIV affect oral squamous cell carcinoma?
tumor has same risk factors in HIV pts as in normal population but tends to occur at a younger age
What kind of drugs are used in HAART?
Reverse transcriptase inhibitor
protease inhibitor
integrase inhibitor
CC5 inhibitors
