HIV-related oral disease

doi:10.1016/S0140-6736(96)02308-2

The Lancet

Volume 348, Issue 9029, 14 September 1996, Pages 729-733

https://doi.org/10.1016/S0140-6736(96)02308-2 Get rights and content

Summary

Few people with HIV infection fail to experience oral lesions during the course of their disease. Oral mucosal and salivary gland manifestations include several that were not seen before the AIDS epidemic, while others are more severe in this population. Oral lesions reflect HIV status and the stage of immunosuppression, are important elements in HIV staging and classification schemes, raise pertinent questions about mucosal aspects of immunosuppression, and provide therapeutic challenges. Their pervasive nature and biological significance emphasise the importance of a careful oral examination as part of the general clinical evaluation.

Section snippets

Oral candidosis

Oral candidosis, the commonest oral fungal disease, is often a part of the acute HIV syndrome² as well as a common problem when the CD4 count falls.³ Candida albicans is the predominant species, but C tropicalis, C glabrata, and C krusei occur occasionally and this diversity has implications for choice of and response to therapy. Oral candidosis has several distinct clinical forms. Pseudomembranous candidosis (thrush) is characterised by removable white or creamy plaques consisting of a mixture

Oral hairy leukoplakia

Oral hairy leukoplakia (HL) is a white lesion of the tongue which we first saw and investigated in 1981 and published the initial report of its existence among homosexual men in San Francisco in 1984.¹³ HL occurs in all risk groups and world wide.3, 14 It is a little less common in women than in men and is rare in children. In HIV-positive persons, HL heralds more rapid progression to AIDS.3, 6, 13 HL is also seen in other forms of immunosuppression–eg, among organ or bone-marrow recipients and

Other herpes viruses

Herpes simplex virus causes both primary and recurrent oral disease. The primary event manifests as fever, lymphadenopathy, gingivitis, and painful oral lesions that start as vesicles and then rupture to form ulcers. These lesions can occur on any mucosal surface. Recurrent herpes simplex affects the lips or the intraoral mucosa. Herpes labialis appears as small vesicles that rupture, ulcerate, and then form a crust. The intraoral lesions are usually confined to the keratinised mucosa and begin

Periodontal disease

Some unusual and often severe periodontal infections are seen in individuals with HIV infection. Linear gingival erythema (formerly known as HIV-gingivitis) is a red band at the gingival margin in children or adults. It does not seem to be due to inflammation, is frequently not associated with plaque accumulation, and may not completely resolve with therapy directed towards gingivitis. Rather than a gingivitis, this disorder may represent hyperaemia due to vasoactive cytokines. A more serious

Aphthous ulcers

Recurrent aphthous ulcers (RAU) may not be more common among people with HIV infection but they are more severe and prolonged.³⁵ In contrast to recurrent intraoral herpes simplex, RAU occur on non-keratinised mucosa such as the buccal and labial mucosa and the lateral margin of the tongue. Minor RAU appear as ulcers 2–5 mm in diameter, covered with pseudomembrane and surrounded by an erythematous halo. Major RAU (figure 2) are large, over 1 cm in diameter; they may persist for months and cause

Salivary gland disease

Enlargement of the salivary glands due to infiltration by CD8 lymphocytes is seen in both adult and paediatric HIV infection (figure 3). Some of these glands undergo cystic change, and such benign lymphoepithelial cysts occasionally cause pain. The cause of HIV-related salivary gland disease is unclear, for no aetiological agents have been identified. It could represent a relatively beneficial host CD8 response, diffuse infiltrative lymphocytosis syndrome or DILS³⁷ the lymphocytes may be

Kaposi's sarcoma

Oral lesions of Kaposi's sarcoma (KS) are common in HIV infection and may be the first presentation of this condition. The role of oral transmission of the putative KS herpesvirus (HHV8) has yet to be determined. Oral KS lesions occur most commonly on the palate, although any oral site may be involved. The lesions appear first as small red or purple patches; later they become nodular and ulcerate if traumatised, causing pain. Large lesions may be unsightly and interfere with speaking and

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma is the other AIDS-associated malignancy that can present in the mouth. The disease may appear as a swelling, sometimes mimicking dental infection, or as single or multiple ulcers. Biopsy is necessary to distinguish the lesion from other causes of prolonged oral ulcers, such as major RAU and opportunistic infections. Multifocal ulcerative lymphoma occurring as ulcers on several mucosal surfaces has been described, as has oral lymphoma which disappeared and then reappeared.³⁸

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Cited by (109)

Diseases of the tongue
2016, Clinics in Dermatology
The tongue is a complex organ involved in speech and expression as well as in gustation, mastication, and deglutition. The oral cavity, along with the tongue, are sites of neoplasms, reactive processes, and infections, and may be a harbinger of systemic diseases. This review includes both common and rare diseases that occur on the tongue, including: vascular and lymphatic lesions (infantile hemangiomas and oral varices), reactive and inflammatory processes (hairy tongue, pigmented fungiform papillae of the tongue, benign migratory glossitis, and fissured tongue), infections (oral hairy leukoplakia, herpes simplex and varicella-zoster virus infections, human papillomavirus, and candidiasis), premalignant lesions (leukoplakia and erythroplakia), malignant lesions (squamous cell carcinoma, Kaposi sarcoma, and lymphoproliferative diseases), and signs of systemic disease (nutritional deficiency and systemic amyloidosis).
General Clinical Manifestations of Human Immunodeficiency Virus Infection (Including Acute Retroviral Syndrome and Oral, Cutaneous, Renal, Ocular, Metabolic, and Cardiac Diseases)
2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases
Oral epithelial changes in HIV-positive individuals
2013, Pathology Research and Practice
HIV infections frequently affect the oral cavity, and local changes may be utilized as indicators of immunosuppression in HIV-positive patients. Morphometric and morphological features of the lining, masticatory, and specialized epithelium of the oral mucosa were studied in 12 HIV-positive and 12 HIV-negative patients autopsied from 2007 to 2010. Mucosal samples from the cheek, gingival, and tongue of 24 individuals were fixed in Carnoy solution and stained with hematoxylin–eosin. Various morphometric characteristics (epithelial thickness, number of cell layers, mean cell diameter) and morphological parameters (basal layer hyperplasia, exocytosis of inflammatory cells, glycogenic acanthosis, cell ballooning degeneration) were then measured. The HIV-positive group had a greater epithelial thickness (mean: 304.4 μm) and a higher mean cell diameter (11.84 μm), whereas the HIV-negative group had more epithelial layers (26.7). Basal layer hyperplasia did not differ significantly between the two groups, but exocytosis of inflammatory cells, glycogenic acanthosis, cell ballooning, and spongiosis were more prevalent in the HIV-positive group. Our findings demonstrate that HIV infection causes diverse epithelial changes in the oral cavity, including thickening, increased cell diameter, increased migration of inflammatory cells, and inter- and intra-cellular edema.
Early and nonreversible decrease of CD161<sup>++</sup>/MAIT cells in HIV infection
2013, Blood
HIV infection is associated with immune dysfunction, perturbation of immune-cell subsets and opportunistic infections. CD161⁺⁺CD8⁺ T cells are a tissue-infiltrating population that produce IL17A, IL22, IFNγ, and TNFα, cytokines important in mucosal immunity. In adults they dominantly express the semi-invariant TCR Vα7.2, the canonical feature of mucosal associated invariant T (MAIT) cells and have been recently implicated in host defense against pathogens. We analyzed the frequency and function of CD161⁺⁺/MAIT cells in peripheral blood and tissue from patients with early stage or chronic-stage HIV infection. We show that the CD161⁺⁺/MAIT cell population is significantly decreased in early HIV infection and fails to recover despite otherwise successful treatment. We provide evidence that CD161⁺⁺/MAIT cells are not preferentially infected but may be depleted through diverse mechanisms including accumulation in tissues and activation-induced cell death. This loss may impact mucosal defense and could be important in susceptibility to specific opportunistic infections in HIV.
SFOT Surgery
2023, Surgically Facilitated Orthodontic Therapy: An Interdisciplinary Approach
HIV testing behaviors and willingness to receive oral rapid HIV testing among dental patients in Xi'an, China
2021, PLoS ONE

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SeriesHIV-related oral disease

Summary

Section snippets

Oral candidosis

Oral hairy leukoplakia

Other herpes viruses

Periodontal disease

Aphthous ulcers

Salivary gland disease

Kaposi's sarcoma

Non-Hodgkin lymphoma

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

Lancet

Oral Surg Oral Med Oral Pathol

J Invest Dermatol

Cell

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

J Am Dent Assoc

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

Primary HIV infection: clinical, immunologic, and serologic aspects

Oral candidiasis in HIV infection: pseudomembranous and erythematous candidiasis show similar rates of progression to AIDS

AIDS

The prevalence of oral lesions in HIV-infected homosexual and bisexual men: three San Francisco epidemiological cohorts

AIDS

Time from HIV seroconversion to oral candidiasis or hairy leukoplakia among homosexual and bisexual men enrolled in three prospective cohorts

AIDS

Prognostic significance of oral lesions in children with perinatally acquired human immunodeficiency virus infection

Am J Dis Child

Candidiasis and HIV infection: virulence as an adaptive response

The identification and tracking of Candida albicans isolates from oral lesions in HIV-seropositive individuals

J Acquir Immune Defic Syndr

Series
HIV-related oral disease