Oral manifestations of HIV and AIDS infection

2021-02-02 12:00 AM

Periodontal disease associated with HIV infection often has more severe symptoms than the conventional periodontal disease, has a poorer response to classical treatment.


1996 - The European Economic Community publishes a classification of oral manifestations of HIV infection

Fungal infections

Candida infection (pseudomembranous form, erythematous form, neoplastic form, lipoderma).


Crytococcus infection.

Infect Geotrichosis.


Necrotic gingivitis - HIV.

Gingivitis - HIV.

Periodontitis - HIV.

Do Mycobacterium avium intracellulare, Klebsiella pneumoniae, Enterobacterium cloacae, E. Coli


Cat scratch disease.


Exacerbation of tooth apex infection.

Cellulitis under the jaw.

Virus infection

Herpes Simplex Virus.

Cytomegalo virus.

Epstein Bar virus: Hair leukoplakia.

Varicella – Zona virus: Herpes Zoster; Varicella.

Human papilloma virus: Verruca vulgaris; Condyloma accuminata; Focal epithelial hyperplasia.

New born

Kaposi sarcoma.

Squamous cell carcinoma.

Non-Hodgkin's Lymphoma.

Neurological disorders

Trilateral nerve disease.

Facial paralysis.

Undefined reason

Recurrent aphte ulcers. 

Lack of primary profile.                    

Dry mouth.

Sequential necrotic ulcers.

Typical epithelial poisoning.

Slow to heal.

Enlarged salivary glands.

Increased Melanin chromosome.

Opportunistic fungal infection

Candida infection

Since the first reports in 1981 about AIDS have mentioned oral candidiasis. However, at that time almost all cases were in the form of pseudomembranes. In the latter, pseudomembranous membranes, erythema, proliferation, and marginal edema have all been described with different rates of seropositive, with ARC and with AIDS.

Candidiasis pseudomembranous

Presence of white or yellow patches on a red or normal mucosa. When scraping, the white flakes flake off leaving a bloody surface. Common location in the palate, cheek mucosa, lips and back of the tongue.

Candidiasis proliferative form

Characterized by white patches that cannot be shaved off. The site is usually the cheek lining, in contrast to the corner of the mouth, which is common in people who are not infected with HIV

Candida erythema or atrophic form

Presented as a prominent or very discreet dark red lesion. The common location in the female mouth, back of the tongue (loss of the tongue) is similar to the multiple infections in patients who smoke a lot. clinical symptoms make the patient uncomfortable.

Candidiasis of the tip of the mouth

Occurs when a patient in middle age does not have the common etiological factors such as anemia, vitamin deficiency, loss of vertical size that must suggest HIV infection.

The proportion of people infected with HIV with a candida infection varies greatly depending on the criteria of the diagnosis of the infection and the survey sample (about 66%). Candidiasis has been studied as a predictor of the transition to AIDS, especially candida infection in the form of a pseudomembrane.

Klein compared 22 patients with systemic lymphadenopathy, a reversible T4 / T8 ratio, and concomitant pseudomembranous candidiasis, with 20 patients with similar but no candidiasis. Follow-up for 3 months showed that the first group 59% turned AIDS with severe opportunistic infections, or Kaposi's sarcoma while the second group did not turn to AIDS.

Thus it can be concluded that a decrease in the number of T4 Lymphocytes with a candida infection is a bad prognostic sign, heralds the emergence of AIDS in HIV-infected patients.


Histoplasma capsulatum is a soil-borne fungus that does not cause disease in normal humans, despite having an immune response. In immunocompromised diseases, fungal pathogens are diffuse or local, with persistent fever, weight loss and lung symptoms, and can also cause damage to the skin and mouth.

Crytococcus, white Geotricum

These are opportunistic fungal infections in HIV-infected patients with stage of AIDS, but relatively rare.

Opportunistic infections

Periodontal disease

Periodontal disease associated with HIV infection often has more severe symptoms than normal periodontal disease, has poor response to classical treatment, progresses more rapidly, causes bone loss and more tooth roots.


The sign is usually a red border of the gums with red inflammatory spots in the alveolar mucosa, and the gums bleed easily despite good oral hygiene and less plaque buildup. Red inflammation spots may be caused by superinfection of Candida. Occasionally swollen gingival spines in several spots.

Periodontal inflammation

Periodontal tissue is destroyed quickly, aching a lot, and teeth are loose. Contrary to conventional periodontal disease, there is a loss of supportive tissues but the sac is not deep. May be accompanied by necrotic ulcerative gingivitis.

Necrotic ulcerative gingivitis: ANUG

Usually only seen in malnourished children, or diseases that impair the immune system. An HIV-infected adult also sees ANUG easily.

Pathogenic bacteria, in addition to some common bacteria in periodontal diseases, there are also some highly toxic anaerobic bacteria such as: Eikenella, Wollinella, Bacteroides, due to HIV infection creating favorable conditions. The beneficial bacteria in the gum slot are converted to more pathogenic strains. Usually, patients with inflammatory periodontitis have a lower T4 / T8 coefficient than those with gingivitis, and also have a defect in polymorphonuclear leukemia function.

Treatment: all forms of periodontal disease in HIV-infected people must be treated with thorough oral hygiene, with additional measures to wash lesions with Betadine 10% and rinse daily with 0.1-0, 2 chlorhexidine gluconate until the cure. Patients with acute pain and injury must be treated with antibiotics against gram-negative anaerobic bacteria.

Tuberculosis infections: Tuberculosis (Mycobacterium tuberculosis) infection increases significantly in HIV-infected people. Tuberculosis lesions in the mouth may appear as tongue sores.

Infect Mycobacterium avium cellulare (MAI)

Infection of the lungs, in the mouth can create ulcers with an inflammatory response to granulomas and bone necrosis.

Infection of Klebsiella pneumoniae and Enterobacterium cloacae

Can cause ulcers in the tongue, mouth.

Opportunistic virus infection

Herpes Simplex

In HIV-infected patients, Herpes stomatitis occurs at the rate of 5-13%, causing more serious and widespread damage than in non-HIV infected people, the disease is persistent, difficult to cure completely and easily relapses. Treatment: Acyclovir.

Varicella Zoster virus

VZV infection can be seen as an early symptom of HIV infection. An HIV-infected patient with VZ has 23% of AIDS after 2 years and 46% of AIDS after 4 years. Treatment: Acyclovir.

Human papilloma Virus (HPV)

HIV infection seems to make it more likely to contract oral HPV with less common types of HPV such as types 13, 18, 32 and cause soft lesions such as papilloma, verruca, condyloma, focal epithelial hyperplasia, and carcinoma.

Hairy Leucoplakia (Hairy Leucoplakia)

HL was first described in late 1981 in San Francisco, and then reported to be quite common in HIV-infected patients in many countries.

It is a common lesion in a patient with advanced HIV infection and AIDS in the form of a white patch, usually found on the side of the tongue, on both sides. The surface is ruffled like hair, sometimes with a flat, smooth surface. Common location on the tongue hip, tongue and less common in the cheek mucosa, lips, mouth floor, soft palate, pharynx. Sometimes the lesions cause burning pain due to superinfection of candida.

Histological imaging shows the proliferation of the spiny and horny layer, which causes the epithelium to thicken and sometimes to create hair-like folds. In the epithelium there are swollen cells that resemble the koilocytes of HPV infection.

However, the lab studies do not allow to detect HPV but Epstein - Bar virus (EBV) in these lesions. There are currently two hypotheses to try to explain why EBV is superinfected on HIV, either because HIV infection causes the loss of Lanerhans that causes locally available EBV to be activated or the EBV receptor on the erythrocyte is exposed. when infected with HIV, so it is easy to attach EBV virus.

Hair leukoplakia is the most characteristic lesion of oral HIV infection and allows for the prediction of progression to AISD stage but requires differential diagnosis with a number of other white lesions. Treatment: AZT.

New born

There are three types of neoplasm that have been reported to be associated with HIV infection. These neoplasms are either caused by a carcinogen, a carcinogenic virus that causes cancer to occur in an immunocompromised person, or by another pathogenic mechanism of HIV.

Sarcom Kaposi

In 1872, Moritz Kaposi described a type of tumor called "Multiple idiopathic hemorrhagic sarcoma" and considered it a malignant tumor of the capillary wall cells, occurring in Africans at a low rate. When the HIV epidemic appeared in San Fransisco, Sarcom Kaposi attracted attention because of its prevalence in the homosexual group, and the suspected pathogen was CMV virus. However, attempts to isolate the CMV virus have all failed. It is currently impossible to exclude the possibility that Kaposi's sarcom is not a true neoplasm but as a result of HIV-induced angioproliferative factor (angioproliferative factor).

In AIDS patients, Kaposi's sarcom usually has multiple lesions, starting with a rash, papules or red papules appearing on the skin or mucosa. In addition, the common location is in the body, legs, and arms. On the face, a characteristic position is the tip of the nose. The skin lesions spread and darken gradually, and nearby lesions stick together. Sarcom Kaposi can also affect the internal organs. In the mouth, Sarcom Kaposi was first noticed in 1982 in the homosexual group in San Fransisco and then, in 1988, a follow-up study of 134 patients showed that this lesion usually appeared at mean age. is 34 years old, 45% has concomitant skin lesions and 22% occurs first.

Kaposi in the mouth can be seen as the first sign of AIDS. The common place in the mouth is the palate, especially on one side of the palate, followed by the gums and tongue. Injured gums are difficult to distinguish from Epulis. Lesions begin as a reddish-greenish or black-red patch, then gradually enlarge, darken and become raised, with an ulcerated surface or multiple zones. Lesions are usually slightly solid before the surface ulcer.

Micrograph of Kaposi sarcoma is very characteristic, showing proliferation of interlocking, spindle-patterned or slightly swollen endothelial cell bands When Kaposi's sarcoma appears concurrently with an opportunistic infection , the average survival time of the patient is from 6 to 9 months.

Non-Hodgkin Lymphoma: NHL

NHL appears in HIV-infected patients at a higher rate than in normal people. NHL is usually related to B lymphocytes and may contain EBV virus, DNA.

NHL is very rare in the mouth compared to other locations in the mouth such as lymph nodes, bone marrow, liver, and meninges. In the mouth, positions are noted: Waldeyer's ring, gums and parotid glands, causing soft tissue to proliferate and destroy underlying bone.

Squamous cell carcinoma

In HIV patients, it has been reported that squamous cell carcinoma occurs in the mouth, on the tongue, in homosexual patients.