3. HUMAN IMMUNODEFICIENCY VIRUS AND
ACQUIRED IMMUNODEFICIENCY SYNDROME
• HIV is a single-stranded RNA virus belonging to the family Retroviridae.
There are two species: HIV-1 and HIV-2.
• The RNA integrates into DNA of cells and replicates in subset of T cell called
CD4 CELLS which are important in immune systems Reponses
• If the HIV left untreated the number of cells will decrease, putting the
patient for variety of infections
• CD4 to very low level lead to syndrome called acquired immune deficiency
disease (AIDS)
• The definition of AIDS is when number of CD4 bellow 200 cells.mm3 of
blood or the patient develop one or more opportunistic infections
regardless to number of CD4
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11. candidiasis
• Its a common finding in HIV infections
• Occur during the :
1. Acute stage of HIV
2. Falling in the CD4 during the middle and late stage of HIV
• Lesions on the hard palate, tongue and soft palate
• These lesions may be associated with:
1. Burning mouth
2. Problems during eating
3. Changes in taste
14. pseudomembranous candidiasis( oral thrush)
• Pseudomembranous candidiasis, also known as oral thrush, is the classic
and most common presentation of oral candidiasis
• It typically presents with extensive white patches that can be easily
removed with gauze, leaving an erythematous mucosa surface.
• The pseudo membrane is formed by desquamated epithelial cells, fibrin,
and fungal hyphae.
• The lesions are usually asymptomatic and appear on the tongue, labial and
buccal mucosa, gingival tissues, hard and soft palate, and oropharynx.
• If symptomatic, patients report a burning sensation in the mouth, oral
bleeding, and changes in taste perception
15. erythematous candidiasis
• Acute atrophic candidiasis presents as a generalized or localized
erythema on the oral mucosa, most commonly on the palate. Still, it
may also develop on the buccal mucosa and tongue's dorsum.
• Atrophy of tongue papillae may accompany the erythema. Patients
usually seek consultation due to a burning sensation in the mouth or
tongue. Therefore, it should be included in the differential diagnosis
of a sore tongue
16. angular cheilitis
• Angular cheilitis presents as erythematous fissured patches and
ulceration in one or both commissures of the mouth, but it is typically
bilateral.
• The lesions are usually painful and sore.
• A moist environment due to the accumulation of saliva in the corners
of the mouth favors Candida growth.
17. Treatment
• Treatment focuses on Candida species.
• Topical antifungal therapy is the first-line therapy
• Systemic antifungal therapy is usually reserved for patients who are
refractory to topical treatment, those who are intolerant to topical
therapy, and those at increased risk of developing systemic infections
• Systematic AF:
1. Fluconazole
2. Ketoconazole
3. itraconazole
18. Oral hairy leukoplakia
• Oral hairy leukoplakia, is a mucosal disease associated with Epstein–
Barr virus infection and almost exclusively occurring in people with
immunosupression.
• The pathogenesis of oral hairy leukoplakia is complex and includes an
interplay of persistent Epstein–Barr virus replication and virulence,
systemic immunosuppression and suppression of the local host
immunity.
• The differential diagnoses include oral candidiasis, lichen planus,
tobacco-associated leukoplakia, human papillomavirus–induced oral
intraepithelial neoplasia, and oral squamous cell carcinoma
20. Non-Hodgkin lymphoma
• Non-Hodgkin lymphoma (NHL) is a cancer of lymphocytes. These are
white blood cells that help to fight infections. Lymphocytes travel
around body in lymphatic system, which is part of immune system.
• The lymphatic system includes lymph nodes (glands) as well as organs
of immune system like thymus, spleen and bone marrow.
• In NHL, lymphocytes keep dividing and grow out of the body’s
control. Over time, the number of abnormal lymphocytes increases
and abnormal lymphocytes collect in lymph nodes, or elsewhere in
the body.
21. • Large size of exophytic growth, covered by pseudomembranous
slough and erythematous areas over the mucosa with everted
margins .
• On palpation, it is tender and firm in consistency.
22.
23. Kaposi’s sarcoma
• is the most common neoplasm in patients with AIDS and is amulti-
focal vascular tumor involving skin and the other organs
• The pathogenesis of KS is related to human herpes virus type 8 (HHV-
8) .This virus is transmitted through sexual contact
• The clinical characteristics are variable, usually beginning as
erythematous, violet or brownish, asymptomatic macules that
develop into papules, plaques, nodules or tumor lesions that mostly
occur in the hard palate
24.
25. Periodontal disease
• linear gingival erythema
• A persistent, linear, easily bleeding, erythematous gingivitis has been
described in some HIV-positive patients.
• The intensity of the erythema is disproportionate to the amount of
plaque present.
• There is no ulceration, pocketing, or attachment loss, and the
condition does not respond predictably to conventional periodontal
therapy.
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27.
28. How to determine if the periodontitis is HIV
related?(HIV) RELATED PERIODONTITIS
• Patient history, clinical examination, lab investigation.
• Sever pain
• Rapid onset
• Rapid destruction
• On clean mouth
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30. Oral manifestation of HIV
• HIV related oropharyngeal lesion caused due to secondary infections
(because the decrease of patient immunity)
31. Fungal Infections: Candidiasis
•Pseudomembraneous Candidiasis
• White “curd-like” raised material that wipes off
•Erythematous / Atrophic Candidiasis
• Mucosal erythema and/or patchy depapillation of the tongue
•Hyperplastic Candidiasis
• White/red hyperplastic lesions
•Angular Cheilitis
• Erythema and/or fissuring-ulceration at the corner of the mouth
36. histoplasmosis
• Histoplasmosis is a disease caused by the fungus Histoplasma capsulatum.
• Histoplasmosis is one of the most frequent opportunistic infections caused
by fungal pathogens among people living with HIV
• Common clinical manifestations include fever, fatigue, malaise, anorexia,
weight loss, and respiratory symptoms.
• Physical examination frequently reveals lymphadenopathy, hepatomegaly,
and/or splenomegaly, with skin and oral lesions less common
• Gingival manifestations include ulcerative and painful granulomatous
lesions
37.
38. Human Herpesviruses as Copathogens of HIV
Infection
• HIV-induced disruption of the equilibrium between a human host and
its virome leads to two grave consequences: (1) Reactivation of
viruses (copathogens), which start to replicate to higher levels, for
example, HHVs and (2) infection by new viruses (coinfections)
39.
40.
41. Human papillomavirus and oral manifestations in a
patient with HIV
• Papillomas can also occur in patients with HIV. Papillomas are benign
exophytic growths (warts) that can occur anywhere in the human
body. The surface of such papillomas have characteristic numerous
finger-like projections and usually appear necrotic due to thrombosed
capillaries.
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44. Aphtous ulcerations due to HIV
• Recurrent aphthous ulcers are a common condition among the
general population. Although the majority of cases are benign and
spontaneously resolve in less than two weeks, these ulcers may be
indicative of an underlying systemic disease such as vitamin
deficiency or immune disturbance. Recurrent aphthous ulcers (RAU)
are usually classified as minor, major, and herpetiform according to
the ulcer size and number.
• Patients with human immunodeficiency virus (HIV) infection often
suffer from persistent, painful ulcers that commonly occur on the
soft palate, buccal mucosa, tonsillar area or tongue, which are
referred to as aphthous ulcers.
45. • The diagnosis of HIV-induced RAU requires a careful history of the
condition. Oral mucosal biopsies are required for non-healing ulcers
in order to exclude the possibility of deep fungal infections, viral
infections, and neoplasms.
