HIV Infection

Question 1

HIV features?

Answer 1

Retrovirus

• Single stranded RNA virus
• Reverse transcriptase gene
• Spread is by body fluids
• Mainly by unprotected sex or IV drug use
• HIV damages immune and nervous system

Cellular receptor of HIV is CD4 molecule
Found on T helper cells, monocytes and dendritic cells
Cells most affected are CD4 helper T cells
Damage causes severe immunodeficiency
Broad spec of illnessess related to level of immunodeficiency
AIDs occurs with CD4 cell counts <200/uL (normal >600)

Question 2

Stages of HIV infec?

Answer 2

Exposure to virus
= Acute seroconversion illness (feels like flu) 
= Symp but HIV positive
= Persistent generalised lymphadenopathy
= AIDs-related complex
- Pyrexia
- Diarrhoea
- Weight loss
- Fatigue/malaise 
= AIDS 
- Opportunistic infec
- Kaposi's sarcoma 
- CD4 T cells <200 

AIDs can develop after 8-10yrs

Question 3

HIV diagnosis?

Answer 3

History and clinical features
Lab investigations
- Lymphopenia
- CD4 count reduced
- CD4/CD8 ratio reduced

HIV testing (after counselling)

• HIV antibodies
• HIV antigens

Question 4

HIV oral manifestations?

Answer 4

Group 1

• Strongly associated with HIV infec
• Candidosis
• Hairy leukoplakia (lesions are bilateral and not premalignant - caused by EBV)
• HIV associated PD
• Kaposi’s sarcoma
• Non-hodgkin’s lymphoma
• Erythematous candidosis
• Pseudomembranous candidosis

Group 2

• Less commonly associated with HIV
• Idiopathic thrombocytopenic purpura
• Salivary gland disorder
• Viral infecs other than EBV

Group 3

• Possibly associated with HIV
• Oral bac infecs other than PD
• Fungal infecs other than candidosis
• Melanotic hyperpigmentation
• Neurological disturbances (facial palsy, trigeminal neuralgia)

Question 5

What bacteria cause HIV periodontal disease?

Answer 5

Spirochaetes
Fusiform bacteria
Anaerobic rods

Question 6

Management of HIV PD?

Answer 6

Immediate:
Removal of necrotic bone and severely involved teeth
Debridement of necrotic tissue
6% hydrogen peroxide irrigation of pockets/MW
Antibiotics - metronidazole
OH instruction

Long term
- Perio management

Question 7

Management of kaposi’s sarcoma?

Answer 7

RT
Systemic chemotherapy
Intra-lesional chemoradiotherapy
Surgical excision

Question 8

HIV prevention?

Answer 8

Condom use
Medical male circumcision
Use of anti-retrovirals for prevention

Question 9

Management of HIV?

Answer 9

Systemic tx

• Modern combination anti-retroviral therapy
• Prophylactic tx for opportunistic infecs
• Provided by HIV clinics, GUM clinics, GMP

Dental care and OH
- GDP

Question 10

How to manage a needle stick injury?

Answer 10

Encourage bleeding under running water
Wash and cover wound
Irrigate exposed eyes, nasal or oral mucosa
Record details in accident book

Occupational health/GMP
- Counselling re post exposure prophylaxis with AZT, HIV testing
Risk assessment
- Identify pt

Follow up

• Hep B status testing vaccination and tx
• HIV testing