HIV/AIDS related oral lesions

Question 1

Transmission of HIV

Answer 1

Through exchange of blood or blood products
Sexual transmission
Perinatal infection

Question 2

Mechanism of infection of HIV

Answer 2

HIV is retrovirus and infects activated T cells and macrophages via the envelope glycoprotein. It is transferred by dendritic cells that enter lymph nodes are transfer HIV to CD4 T cells

Question 3

HIV course of infection

Answer 3

After the exposure to the infection ( infection happens within 3 months-acute) and pt becomes either HIV seropositive (asymptomatic) or has acute HIV infection (pyrexia, skin rash,, headache, diarrhea, orophayngitis, oral mucosal erythema) they can become asymptomatic again.

Question 4

HIV/AIDS related oral lesions

Answer 4

Pt with oral lesions may progress to AIDS more rapidly compared to pt without oral lesions

Question 5

Group 1: strongly associated with HIV infection

Answer 5

Candidiasis (erythematous, pseudomembranous, angular cheilitis)
Hairy leukoplakia
Kaposi sarcoma
Non-Hodgkins lymphoma
Perio disease: linear gingival erythema, necrotizing gingivitis and periodontitis

Question 6

Candidiasis

Answer 6

Can present in relatively mild immunodeficiency
Pseudomembranous candidosis indicates acute immunosuppression

Usually affects oropharyngeal and oesophageal involvement

Question 7

Perio disease

Answer 7

Linear gingival erythema: non plaque induced, red band involving free gingival margin. Hyperaemia due to vasoactive cytokines

Question 8

Hairy leukoplakia

Answer 8

Not premalignant
White patch that cannot be removed
Commonly on lateral border of tongue-vertical white folds with hairy like surface

Histopathology:
Acanthotic parakeratinieed epithelium
Finger-like keratin projections on the surface
Band of balloon cells in prickle cell layer

EBV + are needed for diagnosis (cells are swollen)

Question 9

Kaposi’s sarcoma

Answer 9

More common in male
most common tumour associated with HIV
It is HHV 8
Involved skin and mucosal surfaces giving red-purple patch and becomes nodular

In early lesions: proliferating endothelial cells, extravasated blood cells, hemosiderin and inflammatory cells

In late lesions: more prominent vascular component and atypical spindle cells

Question 10

Non-Hodgkins lymphoma

Answer 10

In AIDS and severely immunocompromised
Can be associated with EBV

Question 11

HPV in HIV

Answer 11

It is called condiloma acuminatum
Causing venereal wart
Transmitted via oro-genital contact
They fuse together forming sessile or pedunculated papillary lesions
HPV induce hyperplastic changes rather than ballooning like in EBV