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![10/08/2025 PBD
Oral Manifestations of HIV Infection
Type of Infection Oral Disease
Fungal
Candidiasis
- Pseudomembranous, Erythematous,
and Angular Cheilitis
Invasive Fungal Infections
- Histoplasmosis, Mucormycosis, Crytococcosis
Viral
Herpes Simplex
Herpes Zoster
Cytomegalovirus
Hairy Leukoplakia (Epstein Barr Virus)
Oral Warts (Human Papilloma Virus)
Human Herpes Virus–8 [Kaposi’s sarcoma]
Bacterial
Linear Gingival Erythema
HIV-associated periodontitis
Necrotizing Ulcerative Periodontitis
Tuberculosis*
Bacillary angiomatosis*](https://image.slidesharecdn.com/5-251008113123-956df97c/75/5-Oral-Manifestations-of-HIV-powerpoint-10-2048.jpg)
![10/08/2025
Oral Manifestations of HIV Infection
Type of Lesion Oral Disease
Neoplastic
Kaposi’s Sarcoma (KS) [HHV-8]
Lymphoma -Non-Hodgkin’s
Squamous Cell Carcinoma*
Other
HIV-associated Necrotizing Ulceration
HIV-Salivary Gland Disease/Xerostomia
Immune Thrombocytopenic Purpura*
Abnormalities of Mucosal Pigmentation](https://image.slidesharecdn.com/5-251008113123-956df97c/75/5-Oral-Manifestations-of-HIV-powerpoint-11-2048.jpg)
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5. Oral Manifestations of HIV.powerpoint
- 1. 10/08/2025 Oral Manifestations of HIV/AIDS Presenter:Isaac Zulu CBU-SOM Moderator :- Dr Mwanza
- 2.
- 3. 10/08/2025 What is HIV? ‘HIV’stands for Human Immunodeficiency Virus, is the virus that attacks the immune systems, the body’s natural defense system. HIV attacks and destroys a type of white cell called a CD4 cell or T-cell. This cell’s main function is to fight diseases. When a person’s CD4 cell count gets low, they are more susceptible to illnesses. Over time, HIV can destroy so many of your CD4 cells and lead to AIDS, the final stage of HIV infection.
- 4. 10/08/2025 What is AIDS? ‘AIDS’stands for Acquired Immune-deficiency Syndrome, is the syndrome which appears in advance stage of HIV infection. This is the stage of infection that occurs when the immune system is badly damaged and the person become vulnerable to opportunistic infection and illness; those illness said to be AIDS defining condition. When the number of CD4 cells falls 200 cells/mm3,or develop one or more opportunistic illnesses (AIDS defining condition*), the person is considered to have progressed to AIDS.
- 5. 10/08/2025 WHO CLINICAL STAGINGOF HIV Oral DISEASES Clinical Stage 1:- Asymptomatic Persistent generalized lymphadenopathy Clinical Stage 2 Angular cheillits and recurrent oral ulcerations Clinical Stage 3 persistent oral candidiasis, oral hairy leucoplakia, acute necrotizing ulcerative stomatitis, gingivitis or periodontitis Clinical Stage 4 kaposi sarcoma and B cell Non-hodgkin lymphoma.
- 6. 10/08/2025 What are thesigns of HIV/AIDS (oral manifestation) in the mouth? Factors that predispose to HIV-related oral conditions:- 1. CD4+ cell count of less than 200/µL 2. plasma HIV-RNA levels greater than 3000 copies/mL, 3. poor oral hygiene 4. Smoking NB*
- 7. CONT’D The oral cavitymay also be a primary source of infection in any individual, which may spread via the mucosal associated lymphoid tissue or stimulate systemic inflammatory immune responses. 2
- 8. Group 1: Lesionsstrongly associated with HIV infection Candidiasis: Pseudomembranous and erythematous Oral Hairy Leukoplakia Non-hodgkin’s Lymphoma Kaposi’s Sarcoma Periodontal Diseases: Linear gingival erythema, necrotizing ulcerative gingivitis and necrotizing ulcerative periodontitis 4
- 9. Group 2: LesionsLess Commonly Associated With HIV Infection • Bacterial: M. avium and M.TB • Necrotizing Ulcerative Stomatitis • Thrombocytopenic Purpura • Viral: herpes simplex, human papilloma virus & varicella zoster 5
- 10. 10/08/2025 PBD Oral Manifestationsof HIV Infection Type of Infection Oral Disease Fungal Candidiasis - Pseudomembranous, Erythematous, and Angular Cheilitis Invasive Fungal Infections - Histoplasmosis, Mucormycosis, Crytococcosis Viral Herpes Simplex Herpes Zoster Cytomegalovirus Hairy Leukoplakia (Epstein Barr Virus) Oral Warts (Human Papilloma Virus) Human Herpes Virus–8 [Kaposi’s sarcoma] Bacterial Linear Gingival Erythema HIV-associated periodontitis Necrotizing Ulcerative Periodontitis Tuberculosis* Bacillary angiomatosis*
- 11. 10/08/2025 Oral Manifestations ofHIV Infection Type of Lesion Oral Disease Neoplastic Kaposi’s Sarcoma (KS) [HHV-8] Lymphoma -Non-Hodgkin’s Squamous Cell Carcinoma* Other HIV-associated Necrotizing Ulceration HIV-Salivary Gland Disease/Xerostomia Immune Thrombocytopenic Purpura* Abnormalities of Mucosal Pigmentation
- 12. 10/08/2025 Fungal Infections 1. OralCandidiasis Oral candidiasis is the most common intraoral manifestation of HIV infection, predominantly due to Candida albicans. The three common presentations of oral candidiasis are:- pseudomembranous candidiasis, erythematous candidiasis and angular cheilitis.
- 13. 10/08/2025 Pseudo-membraneous Candidiasis Most commonoral lesion appears as multiple creamy white or yellow patches/plaques located anywhere in the mouth that can be rubbed off leaving red surface with or without bleeding.
- 14. 10/08/2025 Pseudomembranous candidiasis more severedisease Pseudomembranous candidiasis mild or moderate disease
- 15.
- 16. 10/08/2025 Erythematous / AtrophicCandidiasis presents as a red, flat, subtle lesion on the dorsal surface of the tongue or on the hard or soft palates It may present as a “kissing” lesion A variant is median rhomboid glossitis: a red smooth depapilated area in the middle of the tongue.
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- 18. 10/08/2025 Treatment - erythematousand pseudomembranous candidiasis Topical treatments for mild to moderate cases Clotrimazole troches :- 10 mg: Dispense 70, dissolve 1 troche in mouth 5 times a day for 14 days Nystatin oral suspension :- 500,000 units: Swish 5 mL in mouth as long as possible then swallow (optional), 4 times a day for 14 days Nystatin pastilles :- 100,000 units: Dispense 56, dissolve 1 in mouth 4 times a day for 14 days
- 19. 10/08/2025 Angular Cheilitis Angular cheilitispresents as fissures or linear ulcers unilateral or bilaterally at the corners of the mouth. It can appear alone or in conjunction with another form of candidiasis.
- 20. 10/08/2025 Treatment Treatment involves theuse of a topical antifungal cream applied directly to the affected areas 4 times a day for the 2-week treatment period.
- 21.
- 22. 10/08/2025 Management of OralCandidiasis • Topical agents 0 Clotrimazole troches 10 mg 0 Clotrimazole 1% cream 0 Nystatin oral suspension 500,000 units/ml 0 Nystatin pastilles 100,000 units • Systemic agents 0 Fluconazole 100mg 0 Itraconazole oral suspension 10mg/10ml 0 Amphotericin B, Voriconazole
- 23. 10/08/2025 Azole Resistant OralCandidiasis Candida albicans Candida glabrata
- 24.
- 25. 10/08/2025 Viral infections 1. HerpesSimplex Virus (HSV) Occurs as an intraoral and perioral variant Severity of mucocutaneous disease increases as CD4 counts decrease below 100 cells/mm3 The presence of HSV infection for more than 1 month constitutes an AIDS-defining condition. HSV infection appears as a crop of vesicles usually on the hard palate and gingiva and/or lips. The vesicles rupture and form irregular painful ulcers
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- 27.
- 28. 10/08/2025 Treatment Treatment for HSVinfection includes systemic therapy with antiviral agents such as Acyclovir Famciclovir Valacyclovir
- 29. 10/08/2025 2. Varicella ZosterVirus (VZV) Herpes zoster/Shingle Oral lesions begin as vesicles or ‘bubbles’ but they later burst to form ulcers or open sores Most commonly on the palate, distributed along a unilateral division of fifth cranial nerve- Follow dermatome for trigeminal nerve Patients often complain about severe pain Treatment: Acyclovir, Valacyclovir or famciclovir
- 30.
- 31. 10/08/2025 3. Cytomegalovirus (CMV) Oral CMV infection is associated with severe immune suppression Observed only in the patient with CD4 count below 100 cells/mm3 in the disseminated form of the disease Present as painful, large, sharply demarcated, and nonspecific ulcerations in any area of the oral mucosa Treatment : Intravenous (IV) ganciclovir or acyclovir may be given in high doses
- 32.
- 33. 10/08/2025 4. Epstein-Barr Virus(EBV) Oral Hairy Leukoplakia Reliable indicator for HIV infection and a predictor for subsequent development of AIDs Presents as a white, corrugated or folded lesion on the lateral borders of the tongue look like thrush but can’t easily be removed
- 34. 10/08/2025 Clinical Diagnosis: Marker fordisease progression (CD4 <300 cells/mm3 ) Definitive diagnosis requires identification of EBV in infected epithelial cells Marker for immune suppression (non-HIV patients) Treatment: Acyclovir, Podophyllum resin OHL usually does not require any treatment, but in severe cases systemic antivirals are recommended.
- 35.
- 36. 10/08/2025 5. Human Papillomavirus(HPV) infection Appear as Exophytic, papillary lesions with a cauliflower-like surface to raised, flat, smooth lesions May be solitary or multiple and painless Treatment: Treatments for HPV include :- surgical removal CO2 laser ablation Cryotherapy Interferon-alpha
- 37.
- 38. 10/08/2025 Peridontal Bacteria Infections HIVassociated periodontal diseases is characterized by bleeding gums, bad breath, pain/discomfort, mobile teeth, and sometimes sores classified into 3 forms :- Linear gingival erythema Necrotizing ulcerative gingivitis (NUG) Necrotizing ulcerative periodontitis (NUP)
- 39. 10/08/2025 Linear Gingival Erythema Presentas a 1-3 mm red band along the gingiva margin and may or may not accompanied by occasional bleeding and discomfort No ulceration is present. No evidence of pocketing or attachment loss. Most frequently in association with anterior teeth, but commonly extends to the posterior teeth Erythema does not respond to removal of local factors (bacterial plaque/calculus) Cause is not known
- 40. 10/08/2025 Treatment Intense oral hygiene Professionalcleanings 0.12% chlorhexidine / povidone iodine
- 41.
- 42. 10/08/2025 Necrotizing ulcerative gingivitis(NUG) NUG is more common in adults than in children The condition is characterized by severe pain, loosening of teeth, bleeding, and halitosis Ulcerated gingival papillae, and rapid loss of bone and soft tissue Patients often refer to the pain as “deep jaw pain.” Although necrotizing gingivitis and necrotizing periodontitis may reflect the same disease entity, they are differentiated by the rapid destruction of soft tissue in the former condition and hard tissue in the latter.
- 43. 10/08/2025 Necrotizing Ulcerative Diseases: Gingivitis& Periodontitis
- 44. 10/08/2025 Treatment Removal of dentalplaque, calculus, and necrotic soft tissues utilizing a 0.12% chlorhexidine gluconate or 10% povidone-iodine lavage Prescribe narrow spectrum antibiotics:- metronidazole 500 mg, dispense 14 to 20 tablets, take 1 tablet twice daily for 7 to 10 days Other antibiotic options include clindamycin and amoxicillin Pain management is extremely important Nutritional supplementation or counseling may be necessary
- 45. 10/08/2025 Neoplasms Kaposi Sarcoma Kaposi’s sarcoma(KS) is a spindle-cell tumour of lymphoendothelial origin. All forms of KS are due to sexually transmitted human herpesvirus 8 KS occurs in four patterns: classical KS, endemic KS, KS in patients on immunosuppressant drugs and AIDS-associated KS. AIDS-associated KS is always a multicentric disease. Early mucocutaneous lesions are macular and may be difficult to diagnose. Subsequently, lesions become papular or nodular, and may ulcerate. KS lesions typically have a red–purple colour but may become hyperpigmented, especially in dark-skinned patients.
- 46. 10/08/2025 CONT’D KS often involvesthe mouth, especially the hard palate .Nodular oral lesions are associated with a worse prognosis Diagnosis: biopsy is required to make a definitive diagnosis although a presumptive diagnosis is sometimes made from clinical presentation and history KS may respond to ART. Chemotherapy should be reserved for those patients who fail to remit on ART
- 47. 10/08/2025 Treatment Management of oralKaposi’s sarcoma includes local and systemic treatment depending on the clinical stage The local treatment can be surgical or laser excision and radiotherapy Systemic treatment is single or combined chemotherapy localized injections of chemotherapeutic agents, such as vinblastine sulfate Oral hygiene must be stressed
- 48.
- 49. 10/08/2025 Oral Pigmentation AZT-induced pigmentation Rule-out Kaposi’s sarcoma
- 50. 10/08/2025 Non-Hodgkin Lymphoma Second mostcommon neoplasm associated with AIDS. It comprises a group of malignant lymphproliferative diseases and is an AIDS-defining condition. Lesions tend to present as large, painful, ulcerated mass on palate, gingival tissues and may progress rapidly. Biopsy- for definitive diagnosis. Treatment requires systemic combination of chemotherapy and occasional radiotherapy.
- 51.
- 52. 10/08/2025 Conclusion Oral conditions seenin association with HIV disease are still quite prevalent and clinically significant. A thorough examination of the oral cavity can easily detect most of the common lesions. An understanding of the recognition, significance, and treatment of said lesions by primary healthcare providers is essential for the health and well-being of people living with HIV disease.
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- 54.
Editor's Notes
- #6 For persons living with HIV disease who are not yet on therapy, the presence of certain oral manifestations may signal progression of HIV disease. For individuals with unknown HIV status, oral mani-festations may suggest possible HIV infection, although they are not diag-nostic of infection. For patients on antiretroviral therapy, the presence of certain oral manifestations may signal an increase in the plasma HIV-1 RNA level.
- #13 This type most often affects the tongue, although every area of the oral mucosa may be affected. diagno-sis is based on appearance.
- #16 if a lesion is present on the tongue, the palate should be examined for a matching lesion, and vice versa.
- #17 The condition tends to be symptomatic, with patients complain-ing of oral burning, most frequently while eating salty or spicy foods or drinking acidic beverages. Clinical diagnosis is based on appearance, as well as on the patient’s medical history and virologic status. The presence of fungal hyphae or, more likely, blastospores can be confirmed by performing a potassium hydroxide (KOH) preparation.
- #18 nystatin oral suspension contains 50% sucrose, which is cariogenic; this is less of a potential problem if fluoride is prescribed along with the nystatin.
- #19 Hyperkeratosis may be present peripheral to the fissure
- #41 Periodontal Considerations: Linear Gingival Erythema (LGE) Clinical Features: Distinct erythematous band which can extend into the alveolar mucosa. Localized or generalized. Bleeds on probing; often edemaous. No attachment loss. Unrelated to plaque. Differential Diagnosis: Distinct from gingivitis in that it does not necessarily respond to scaling or plaque control. Treatment and Management: Scaling, root planing, chlorhexidine and treatment with an antifungal for the non-responders. This lesion may, but not necessarily, progress on to necrotizing ulcerative periodontitis. Prevalence among the HIV population is unclear although clearly less than 10% and may be much lower than this.
- #43 Periodontal Considerations: Necrotizing Ulcerative Periodontitis (NUP) Clinical Features: Severe soft-tissue necrosis and destruction of the periodontal attachment and osseous supporting structure. Significant loss over a very short period of time. Often accompanied by spontaneous gingival bleeding with patients reporting a deep-seated bone pain. Differential Diagnosis: Necrotizing Stomatitits Lymphoma NUG Treatment and Management: Treatment consists of antibiotic therapy (metonidazole/augmentin) along with careful debridement, chemotherapeutics (chlohexidine/betadine) and oral hygiene instruction. Relief for patients is generally achieved with 24-48 hours once antibiotic therapy is instituted.