AIDS and the gateway of the body
Bandyopadhyay, P.; Bhowal, R.N.; Sikdar, S.N.; Roy, A.K.; Roy, J.G.; Bandyopadhyay, D.; Pal, N.C.; Chatterjee, B.D.
Journal of the Indian Medical Association 92(1): 17-19
1994
ISSN/ISBN: 0019-5847 PMID: 8207272 Document Number: 286339
In the early phases of HIV infection, the oral cavity may develop erythematous and pseudomembranous candidiasis, oral hairy leukoplakia (OHL), necrotizing ulcerative periodontal disease, Kaposi's sarcoma, and infections with Herpes simplex viruses, cytomegalovirus, Epstein-Barr virus, and Varicella zoster virus. The leading oral infections are candidiasis and OHL. The most common oral form of candidiasis is pseudomembranous, which appears white and milky and can be easily removed from the mucosal surface. After removal, this surface will bleed and be raw. OHL forms a white, corrugated (hairy) 1 m to 2 cm patch, generally on the lateral borders of the tongue. OHL rarely occurs in persons not infected with HIV. HIV-positive people often experience considerable periodontal destruction, causing much pain. They may also have atypical gingivitis. Painful, indolent oral ulcers are often on the tongue, lip, gingiva, and esophagus. Almost everyone with advanced HIV infection is seropositive for cytomegalovirus. Molluscum contagiosum lesions in HIV-infected persons are larger and more numerous than those in children. Various cutaneous or noncutaneous noninfective conditions (e.g., psoriasis and vasculitis) are also more common in HIV-infected persons. Possible agents to control candidiasis are fluconazole and chlorhexidine oral rinse. Topical or systemic corticosteroids may control aphthous-like ulcers. The drug acyclovir may control herpes virus and other viral infections. If acyclovir is ineffective, desciclovir, ganciclovir, or foscarnet are possible alternatives. Papilloma virus lesions can be treated with cryosurgery, laser therapy, or surgical excision. Radiotherapy, chemotherapy, and interferon are treatments for Kaposi's sarcoma. Aspirin and other nonsteroidal anti-inflammatory drugs may be contraindicated in patients with thrombocytopenia or who are on corticosteroid therapy.