Oral Manifestations of Human Immunodeficiency Virus-Infected Patients

Document Type: Original

Authors

1 Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.

3 General Dentist, Mashhad, Iran

Abstract

Background:
Oral lesions are among the earliest clinical manifestations of human immunodeficiency (HIV) infection and are important in early diagnosis and for monitoring the progression to acquired immunodeficiency syndrome (AIDS). The purpose of this study was to determine the prevalence of oral lesions and their relationship with a number of factors in HIV/AIDS patients attending an HIV center.  
 
Methods:
A total of 110 HIV-positive patients were examined to investigate the prevalence of oral lesions according to the criteria established by the European Community Clearing House on Oral Problems Related to HIV Infection. An independent T-test was used for correlation of oral lesions with CD4+ count and a χ2 test was used for analysis of the relationship of co-infection with hepatitis B virus (HBV), sexual contact, route of transmission, history of drug abuse, and history of incarceration.
 
Results:
Most of the cases were male patients (82.7%). The mean age across all participants was 36.2±8.1 years. Rampant carries, severe periodontitis and oral candidiasis were the most notable oral lesions. Oral lesions were more prevalent in patients between 26–35 years of age. There was a significant difference between patients with and without pseudomembranous candidiasis and angular cheilitis according to mean level of CD4+.
 
Conclusion:
The most common oral presentations were severe periodontitis, pseudomembranous candidiasis and xerostomia. 

Keywords

Main Subjects


1. Patton LL, McKaig RG, Strauss RP, Eron JJ, Jr. Oral manifestations of HIV in a southeast USA population. Oral Dis. 1998;4(3):164-9. Epub 1999/ 02/11.

2. Patton LL, McKaig R, Strauss R, Rogers D, Eron JJ, Jr. Changing prevalence of oral manifestations of human immuno-deficiency virus in the era of protease inhibitor therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89(3):299-304. Epub 2000/03/10.

3. Arendorf TM, Bredekamp B, Cloete CA, Sauer G. Oral manifestations of HIV infection in 600 South African patients. J Oral Pathol Med. 1998;27(4):176-9. Epub 1998/05/01.

4. Patton LL, Phelan JA, Ramos-Gomez FJ, Nittayananta W, Shiboski CH, Mbuguye TL. Prevalence and classification of HIV-associated oral lesions. Oral Dis. 2002;8 Suppl 2:98-109. Epub 2002/08/08.

5. Coogan MM, Greenspan J, Challacombe SJ. Oral lesions in infection with human immunodeficiency virus. Bull World Health Organ. 2005;83(9):700-6. Epub 2005/10/08.

6. Palmer GD, Robinson PG, Challacombe SJ, Birnbaum W, Croser D, Erridge PL, et al. Aetiological factors for oral manifestations of HIV. Oral Dis. 1996;2(3):193-7. Epub 1996/09/01.

7. Beyer T, Czernin J, Freudenberg LS. Variations in clinical PET/CT operations: results of an international survey of active PET/CT users. J Nucl Med. 2011;52(2):303-10. Epub 2011/01/15.

8. Hjerppe A, Saarinen JP, Venermo MA, Huhtala HS, Vaalasti A. Prolonged healing of venous leg ulcers: the role of venous reflux, ulcer characteristics and mobility. J Wound Care. 2010;19(11):474, 6, 8 passim. Epub 2010/12/08.

9. Classification and diagnostic criteria for oral lesions in HIV infection. EC-Clearinghouse on Oral Problems Related to HIV Infection and WHO Collaborating Centre on Oral Manifestations of the Immunodeficiency Virus. J Oral Pathol Med. 1993;22(7):289-91. Epub 1993/08/01.

10. Khatibi M, Moshari AA, Jahromi ZM, Ramezankhani A. Prevalence of oral mucosal lesions and related factors in 200 HIV+/AIDS Iranian patients. J Oral Pathol Med. 2011;40(8):659-64. Epub 2011/02/24.

11. Coulter ID HK, Marcus M, Hays RD, Freed J, Der-Martirosia C, et al. Associations of self-reported oral health with physical and mental health in a nationally representative sample of HIV persons receiving medical care. Quality of Life Research 2002;11:57-60.

 

 

12. Kim LS, Stansell J, Cello JP, Koch J. Discrepancy between sex- and water-associated risk behaviors for cryptosporidiosis among HIV-infected patients in San Francisco. J Acquir Immune Defic Syndr Hum Retrovirol. 1998; 19(1): 44-9. Epub 1998/09/10.

13. Ravikumar VN, Rudresh K, Jalihal U, Satish R, Manjunath R. Clinical and endoscopic spectrum of upper gastrointestinal manifestations in HIV patients. Kathmandu Univ Med J (KUMJ). 2010; 8(29):25-8. Epub 2011/01/07.

14. Li ZC, Zhao Y, Dou ZH, Yu L, Wu H, Zhang FJ. [Clinical features of 66 children with acquired immunodeficiency syndrome]. Zhongguo Dang Dai Er Ke Za Zhi. 2009;11(2):93-5. Epub 2009/02/19.

15. Bendlick C SC, Relchart P.A. Oral Manifestations in 10 Combodian Patients with HIV infection avd AIDS. J Oral Pathol Med. 2002;31:1-4.

16. Sharma G, Pai KM, Setty S, Ramapuram JT, Nagpal A. Oral manifestations as predictors of immune suppression in a HIV-/AIDS-infected population in south India. Clin Oral Investig. 2009; 13(2):141-8. Epub 2008/08/01.

17. Greenwood I ZJ, Robinson PG. changes in the pevalence of HIV-associated mucosal disease at a dedicated clinic over 7 years. Oral Dis. 2002; 8(2):90-4.

18. Glick M, Muzyka BC, Lurie D, Salkin LM. Oral manifestations associated with HIV-related disease as markers for immune suppression and AIDS. Oral Surg Oral Med Oral Pathol. 1994; 77(4):344-9. Epub 1994/04/01.

19. Coates E, Slade GD, Goss AN, Gorkic E. Oral conditions and their social impact among HIV dental patients. Australian dental journal. 1996;41(1):33-6. Epub 1996/02/01.

20. Chidzonga MM. HIV/AIDS orofacial lesions in 156 Zimbabwean patients at referral oral and maxillofacial surgical clinics. Oral Dis. 2003;9(6):317-22. Epub 2003/11/25.

21. Tirwomwe JF, Rwenyonyi CM, Muwazi LM, Besigye B, Mboli F. Oral manifestations of HIV/AIDS in clients attending TASO clinics in Uganda. Clin Oral Investig. 2007;11(3):289-92. Epub 2007/05/04.

22. Hodgson TA. HIV-associated oral lesions: prevalence in Zambia. Oral Dis. 1997;3 Suppl 1:S46-50. Epub 1997/05/01.

23. Tukutuku K, Muyembe-Tamfum L, Kayembe K, Odio W, Kandi K, Ntumba M. Oral manifestations of AIDS in a heterosexual population in a Zaire hospital. J Oral Pathol Med. 1990; 19(5):232-4. Epub 1990/05/01.

24. Kerdpon D, Pongsiriwet S, Pangsomboon K, Iamaroon A, Kampoo K, Sretrirutchai S, et al. Oral manifestations of HIV infection in relation to clinical and CD4 immunological status in northern and southern Thai patients. Oral Dis. 2004; 10(3): 138-44. Epub 2004/04/20.

25. Khongkunthian P, Grote M, Isaratanan W, Piyaworawong S, Reichart PA. Oral manifestations in 45 HIV-positive children from Northern Thailand. J Oral Pathol Med. 2001;30(9):549-52. Epub 2001/09/14.

26. Gabler IG, Barbosa AC, Velela RR, Lyon S, Rosa CA. Incidence and anatomic localization of oral candidiasis in patients with AIDS hospitalized in a public hospital in Belo Horizonte, MG, Brazil. J Appl Oral Sci. 2008;16(4):247-50. Epub 2008/ 12/18.

27. Holmes HK SL. Oral lesions of HIV infection in developing countries. Oral Dis. 2002;8(suppl 2): 40-3.

28. Nittayananta W, Chanowanna N, Winn T. Mode of HIV transmission associated with risk of oral lesions in HIV-infected subjects in Thailand. J Oral Pathol Med. 2010;39(2):195-200. Epub 2009/ 12/17.

29. Sen S MS, Bhattacharya S, Halder S, Bhaumik P. Oral manifestations in humn immunodeficiency virus infected patients. Indian J Dermatol. 2010;55(1):116-8.

30. Ramírez-Amador V E-PL, Sierra-Madero J, Anaya-Saavedra G, González-Ramírez I, Ponce-de-León S. The changing clinical spectrum of human immunodeficiency virus (HIV)-related oral lesions in 1,000 consecutive patients. A twelve-year study in a referral center in Mexico. Medicine. 2003; 82:39-50.

31. Flaitz CM, Nichols CM, Hicks MJ. Oral malignancies diagnosed in an HIV-dedicated dental clinic. Texas dental journal. 1996;113(6):49-57. Epub 1996/06/01.

32. Shiboski CH, Neuhaus JM, Greenspan D, Greenspan JS. Effect of receptive oral sex and smoking on the incidence of hairy leukoplakia in HIV-positive gay men. J Acquir Immune Defic Syndr. 1999;21(3):236-42. Epub 1999/07/27.

33. Pedreira EN CC, Barroso EC, Santos JA,  Fonseca FP, Taveira LA. Epidemiology and oral manifestations of HIV-positive patients in specialized service in Brazil. Journal of Appllied Oral Sci. 2008;16(6).

34. Babamahmoodi F, Heidari Gorji MA, Mahdi Nasehi M, Delavarian L. The prevalence rate of hepatitis B and hepatitis C co-infection in HIV positive patients in Mazandaran province, Iran. Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina. 2012;9(2):299-303. Epub 2012/08/29.