Oral Manifestations of HIV/AIDS Flashcards
1
Q
AIDS (acquired immune deficiency syndrome) key features?
cause, transmission, latent period, effects, common oral lesions, treatment
A
- retrovirus HIV-1 (human immunodeficiency virus)
- transmitted through sexual contact, during pregnancy, at birth or through breast milk
- long latent period
- causes progressive deterioration mainly of cell-mediated immunity
- oral lesions include candidiasis and hairy leukoplakia
- Kaposi’s sarcoma and lymphomas often in oral regions
- Effectively treated with highly active antiretroviral treatment (HAART)
2
Q
What does HAART do?
A
- decrease viral load (viremia)
- increase CD4 count
- direct protease inhibitor on oral candidiasis
- decrease prevalence and incidence of most HIV associated oral lesions (reappearance can be a sign of failing treatment)
3
Q
What are the possible side effects to HAART?
A
- xerostomia
- disturbed taste sensation
- perioral paraesthesia
- can also cause erythema multiforme (autoimmune skin condition characterised by immunocomplexes being deposited in the superficial microvasculature of skin)
4
Q
HIV rIsk to healthcare workers
A
- virus may be transmitted through needle-stick injury
- post-exposure prophylaxis is considered to be more than 90% effective in preventing transmission
5
Q
When are the oral manifestations of AIDS likely to occur?
A
- > 70% of patients with AIDS have orofacial disease
- when circulating CD4 count falls below 200/mm3,
- the viral load exceeds 3000 copies/mL
- or the patient has other predisposing factors such as dry mouth
6
Q
Oral lesions strongly associated with HIV
A
- candidiasis: erythematous and pseudomembranous (thrush)
- hairy leukoplakia (EBV)
- karposi’s sarcoma
- non-hodgkins lymphoma
- periodontal disease
- linear gingival erythema
- ANUG
7
Q
Oral lesions less commonly associated with HIV
A
- mycobacterial infections (M. Tuberculosis)
- melanin pigmentation
- necrotising (ulcerative) stomatitis (the terminal progression of HIV-associated periodontal diseases. Ulceronecrotic infection of the gingiva that extends into contiguous mucosal or palatal tissues, resulting in exposure of bone)
- xerostomia
- HIV salivary cystic disease
- Thrombocytopenic purpura
- ulceration - non specific
- herpes simplex
- condyloma acuminatum (anogenital warts)
- multifocal epithelial hyperplasia (proliferation on the oral mucosa of multiple papulonodular lesions)
- papillomas
- varicella zoster infections (chicken pox)
8
Q
Lesions seen in HIV infections (rare)
A
- bacterial infections (E. coli, Klebsiella pneumoniae)
- cat scratch disease
- facial palsy
- trigeminal neuralgia
- recurrent aphthous stomatitis
- cytomegalovirus infection
9
Q
What can Epstein-Barr virus cause
A
- infectious mononucleosis
- oral hairy leukoplakia
- non-Hodgkin’s lymphoma
- Burkitt’s lymphoma
- nasopharyngeal carcinoma
10
Q
Candidosis and HIV
A
- Erythematous: circumscribed red dull areas
respond to antifungals - Pseudomembranous (thrush): soft with flecks and plaques readily rubbed off
- Linear gingival erythema: considered to be a manifestation of candidosis in the gingival crevice and attached gingiva
scaling, OH, and CHX effective +/- antifungals
11
Q
Viral mucosal infections and HIV
A
- Herpetic stomatitis (HSV)
- causes chronic ulceration unlike the typical infection
- greater risk of intramural secondary herpes infection - Severe orofacial zoster (VZV) indicates disease progression and poor prognosis
- Increased risk of papillomas (HPV)
- HAART increases risk of oral warts: verruca vulgaris, condyloma acuminatum, focal epithelial hyperplasia
- Due to adverse effect of immune reconstitution
- Can be numerous and form large confluent patches
- Difficult to control - repeated excisions, cryosurgery or laser ablation may only keep them under control
12
Q
Oral hairy leukoplakia causes, clinical features and treatment
A
- causes by EBV in immunosuppressed individuals (highly characteristic of HIV)
- Forms soft, corrugated, painless plaques on lateral borders of tongue
- Vertical ridging is an enhancement of the normal morphology on the posterolateral tongue
- Biopsy for diagnosis - shows hyperkeratosis
- No tx required, regresses when immunosuppression improves (e.g. with HAART)
13
Q
Bacterial infections in HIV
A
- infections that otherwise rarely involve the oral tissues can develop (Klebsiella pneumoniae, enterobacter cloacae and Escherichia coli)
- later stages: may be ulcers secondary to systemic infections (M. Tuberculosis)
- Bacillary angiomatosis is vascular proliferative disease caused by Bartonella henselae and can mimic Kaposi’s sarcoma clinically
14
Q
Systemic mycoses in HIV
A
- histoplasmosis or cryptococcosis can give rise to proliferative or ulcerative lesions
15
Q
Malignant neoplasms: Kaposi’s sarcoma
what it is, cause, predisposing factors, clinical features, differential diagnosis, management
A
- Low-grade and relatively malignant multifocal tumour of lymphatics or blood vessels
- Caused by HHV-8
- Most patients are immunosuppressed (HIV mainly but can be from therapeutic immunosuppression)
- Clinical features are flat nodular purplish area that enlarges rapidly which may ulcerate or bleed (mainly palate and gingiva)
- Differential diagnosis: oral purpura, bacillary angiomatosis, pyogenic granulomas
- Management: localised oral lesions excision, chemotherapy, radiation avoided in mouth but widely used in other areas of body, good response to antiretroviral treatment
