HIV and the Oral Cavity*

Question 1

Transmission of HIV?

Answer 1

Sex
Injecting drugs
Blood products
Vertical transmission
Organ transplant

People can be high risk or unknown risk

Question 2

What is AIDS?

Answer 2

Acquired immune deficiency syndrome
Causing a weakened immune system
<200mm of CD4 in blood

Question 3

Clinical stages of HIV presentation - I-IV?

Answer 3

Stage I:
- asymptomatic
Stage II:
- weight loss, herpes, and minor mucocutaneous infections
- hard to differentiate to any other disease
Stage III:
- oral hairy leukoplakia, oral thrush and severe bacterial infect
Stage IV:
- HSV, Kaposi’s sarcoma, candidiasis and pneumocystis pneumonia

Question 4

HIV immunology - what is affected?

Answer 4

Destruction of the CD4 T-helper lymphocytes

Early diagnosis leads to better outcomes so test at any suitable opportunity

Question 5

Undetectable = Untransmittable

Answer 5

Undetectable = Untransmittable

Question 6

Candidiasis - early and late disease and differential diagnosis?

Answer 6

Early diseases assoc with mild oral candida
Late disease leads to extensive oral and oesophageal candidiasis
Differentials:
- diabetes
- steroids
- antibiotics

Question 7

Oral manifestations of HIV - types? relation with HIV? cause?

Answer 7

Oral Hairy Leukoplakia:
- diagnostic
- EBV virus
- asymptomatic
Oral ulcers:
- related to many diseases
- present in acute or late HIV
- multiple severe = HIV
Warts:
- severe = HIV
Oral lymphoma:
- unusual sites = HIV
Kaposi's sarcoma:
- tumour arising from endothelium
- found on skin and palate
Other conditions:
- gingivitis, thrombocytopenia, oral malignancies and HSV
Syphilis:
- snail-track ulcer
- use of pre-exposure drugs stops HIV transmission but has created an increase in other STDs
Molluscum contagiosum:
- pox virus
Seborrheic dermatitis:
- immunodeficiency
- found at nasal folds

Question 8

Drug side effects for HIV patients - appearance related?

Answer 8

Lipodystrophy causes facial changes due to fat redistribution

Question 9

Occupational HIV exposure risk - risk ratio? risk factors?

Answer 9

3/1000 injuries
Factors:
- deep injury
- visible blood on instrument
- needle stick injury from vessel
- HIV related illness

Saliva poses risk to dentists, as most likely to be contaminated with blood

Question 10

What to do following possible exposure?

Answer 10

Wash injury with soap and water without scrubbing
Free bleeding of the wound to be encouraged
Irrigation with water

Question 11

What to do after possible exposure?

Answer 11

Post-exposure prophylaxis
Reduces chance by 80%
Start the sooner the better