HIV CASED BASED DISCUSSION

Question 1

What oral manifestations is HIV linked to

Answer 1

• Severe oral candida infection
• Kaposi sarcoma (purple)
• Hairy oral leukoplakia

Question 2

What are normal CD4+ levels
Normal CD4/CD8 levels
viral load?

Answer 2

CD4+= 500-1500 cell/mm3
CD4/CD8 = >1
vital load= undetectable

Question 3

Treatment for HIV

Answer 3

c ART (antiretroviral therapy) with Biovir+Kaletra
weekly followup
+check for CD4+ CD8+ levels

Question 4

What is Kaposi Sarcoma

Answer 4

• Malignant neoplasm
• Tumor of endothelial cells
• Abnormal vascular proliferation hence the purple colour
• Common with HIV/AIDS
• caused by HHV8 (endotherliotropic virus +angiogenic properties)
• can be called KSHV

Question 5

Presentation of KS

Answer 5

• purple/red/brown macule papule nodule anything
• can effect skin and oral GI mucosa lymph
• common in patients with HIV/AIDS
• usually in PALATE

Question 6

Management of Kaposi sarcoma

Answer 6

• surgical excision
• cryotherapy
• radiotherapy
• cART with protein inhibitors

+FBC

Question 7

What can HIV and candida cause?

Answer 7

palatal perforation

Question 8

3 different types of oral candidosis

Answer 8

ACUTE
pseudomembraneous (wipe off)
erythematous (broad spec antibiotics)

CHRONIC
chronic hyperplastic candidosis/candida leukoplakia (malignant?)
chronic erythematous candidosis (denture stomatitis)

SECONDARY
angular chelitis
chronic mucocutaneous candidosis
median rhomboid glossitis

Question 9

Oral Hairy Leukoplakia

Answer 9

• caused by EBV
• Prevalence: HIV/immunocompromised
• Lateral border of the tongue
• Corrugated
• White, elevated/flat lesions/plaques that don’t wipe off
• asymptomatic

Question 10

Mangement of oral hairy leukoplakia

Answer 10

INVESTIGATIONS

• FBC CD4+ count
• Biopsy of the lesion
• Smear for candida

TREATMENT (treat underyling conditions)

• Nystatin/Miconazole
• cART
• Acyclovir cream 5% 5 times a day

Question 11

If you are on cART bc you have HIV
-CD4+ are increasing (treating HIV)
-but KS lesion was increased
WHY?

Answer 11

Immune reconstitution inflammatory syndrome

Question 12

Immune reconstitution inflammatory syndrome

Answer 12

• This occurs in patients with immunosuppression on cART eg. HIV
• It is a rapid exuberant inflammatory reaction to the immune reconstitution process
• causes the appearance/recurrence/flare up of a previously treated opportunistic infection eg. dormant TB/KS