HIV Infection

Question 1

What is HIV?

Answer 1

Human immunodeficiency virus

Type of retrovirus

Question 2

Give more information of the retrovirus HIV

Answer 2

Single stranded RNA w/ reverse transcriptase gene

Question 3

How is HIV spread?

Answer 3

Bodily fluid - unprotected sex/ IV drug use

Question 4

What does HIV do?

Answer 4

Damage immune and nervous system = severe immunodeficiency

Question 5

Where is cell receptor for HIV found?

Answer 5

CD4 molecule

Question 6

When does AIDS occur?

Answer 6

When CD4 cell count <200/uL

normal >600/uL

Question 7

Steps of HIV infection?

Answer 7

1. Exposure to virus
2. Acute seroconversion illness
3. Asymptomatic - HIV+
4. Persistant generalised lymphadenopathy
5. AIDS-related complex - pyrexia, weight loss, fatige
6. AIDS- opportunistic infections e.g kaposi’s sarcoma

Question 8

How diagnose HIV/AIDS?

Answer 8

Hx and clinical features
General lab investigation - CD4 count, CD4/CD8 ratio
HIV testing

Question 9

What are the different groups of HIV oral manifestations?

Answer 9

Group 1 - strongly associated HIV
Group 2 - less commonly associated
Group 3 - possible association

Question 10

Examples of group 1 oral manifestations?

Answer 10

Candidosis
Hairy leukoplakia 
HIV associated periodontal disease
Kaposi's sarcoma
Non-hodgkin's lymphoma

Question 11

What types of candida can be seen in HIV pts?

Answer 11

Erythematous or pseudomembranous

Question 12

What is tx of candida infections?

Answer 12

Antifungals

Topical - miconazole/ nystatin
Systematic - fluconazole/ itraconazole/ voriconazole

Question 13

How would expect hairy leukoplakia to present?

Answer 13

Bilaterally

Question 14

What is important to remember about hairy leukoplakia?

Answer 14

Not premalgiannt

Question 15

What can cause hairy leukoplakia?

Answer 15

EBV

Question 16

Tx of hairy leukoplakia?

Answer 16

Generally not required

Can regrew w/ acyclovir - return of stopping

Question 17

What types of perio are associated w/ HIV?

Answer 17

Linear gingival erythema
NUG
NUP
NUS - necrotising ulcerative stomatitis

Question 18

What is the aetiology of HIV associated periodontitis?

Answer 18

Spirocheates
Fusiform bacteria
Anaerobic rods

In linear gingival erythema - candida may play role

Question 19

What is immediate management of HIV associated perio?

Answer 19

Removal necrotic bone and severely involved teeth
Debride necrotic tissue
6% hydrogen peroxide irrigation of pocket
Abs - metronidazole
OHI

Question 20

What is long-term management of HIV associated perio?

Answer 20

Periodontal management

Question 21

What causes Kaposi’s sarcoma?

Answer 21

HHV8

Question 22

What is the management of kaposi’s sarcoma?

Answer 22

Radio/chemotherapy

Question 23

What are group 2 lesions associated w/ HIV?

Answer 23

Aytipical oropharyngeal ulceration
Idiopathic thrombocytopenic purpa
Salivary gland disorder
Viral infections

Question 24

What causes idiopathic thrombocytopenic purpa?

Answer 24

Low platelet count resulting in purpuric patches on oral mucosa

Question 25

Problem w/ low platelet count and dentistry?

Answer 25

If XLA risk post-XLA bleed

Question 26

What does salivary gland disorder cause?

Answer 26

Dry mouth due reduced salivary flow rate Due to swelling major salivary glands

Question 27

Tx of salivary gland disorder?

Answer 27

Tx saliva stimulant and oral lubrication

Question 28

What viral infections are associated w/ HIV?

Answer 28

Cytomegalovirus Herpes simplex HPB Herpes zoster

Question 29

What might you see orally w/ cytomegalovirus?

Answer 29

Severe or atypical oral ulcers

Question 30

Examples of group 3 lesions?

Answer 30

Oral bacterial infection (not perio) Fungal infection (not candidiasis) Malanotic hyperpigementation Neurological disturbance

Question 31

What are examples of neurological disturbance caused HIV?

Answer 31

Facial palsy | Trigeminal neuralgia

Question 32

What is the systemic tx provided those w/ HIV?

Answer 32

Modern combination anti-retroviral tx - HAART Prophylactic tx for opportunistic infection Very effective at preventing progression to AIDS

Question 33

What does the tx of HIV aim to do?

Answer 33

Reduce immunosuppression and associated opportunistic infections and tumours

Question 34

What to do if get needle stick/ occupational exposure?

Answer 34

``` Encourage bleeding under running water Apply or scrub w/ antiseptic Cover wound Irrigate exposed eyes, nasal or oral mucosa Record in accident book ``` Report exposure occupational health

Question 35

If occupational exposure occurs what do you need pt permission for?

Answer 35

Bloods - clinical and serological evaluation of HIV/ HBV status

Question 36

What will occupational health arrange?

Answer 36

Post-exposure prophylaxis w/ AZT | HBV/ HIV testing

Question 37

What causes immunosuppression associated w/ HIV?

Answer 37

Depletion of CD4 T helper cells