HIV Infection and the Oral Manifestations of HIV Flashcards
According to WHO for 2006 what are the global figures for people living with HIV, newly infected with HIV and deaths due to AIDs? (3)
- People living with HIV - 39.5million
- Newly infected with HIV - 4.3million
- Deaths due to AIDS - 2.9million
What is HIV? (12)
- Human Immunodeficiency Virus
- Retrovirus
- Single stranded RNA virus
- With a reverse transcriptase gene
- Spread by body fluids
- Mainly by unprotected sex or IV drug use
- HIV damages the immune and nervous system
- Cellular receptor for HIV is CD4 molecule
- Found on T helper cells, monocytes and dendritic cells
- Cells most affected are CD4 ‘helper’ T cells
- Damage causes severe immunodeficiency
- Broad spectrum of illness related to level of immunodeficiency
- AIDS occurs with CD4 cell counts 600/L)
What are the stages of HIV infection? (4, 1+4, 1+3)
Exposure to virus
Acute seroconversion illness
Asymptomatic but HIV+
Persistent generalised lymphadenopathy – PGL
AIDS-related complex – ARC Pyrexia Diarrrhoea Weight loss Fatigue/malaise
AIDS
Opportunistic infections
Kaposi’s sarcoma
CD4 T cells <200/L
How is Human immunodeficiency virus (HIV) diagnosed? (1, 1+3, 1+2)
- History and clinical features
- General lab investigations
- Lymphopenia
- CD4 cound reduced
- CD4/CD8 ratio reduced
- HIV testing (after counselling)
- HIV antibodies
- HIV antigens
What are the three groups of HIV oral manifestations? (3)
- Group 1 lesions: strongly associated with HIV infection
- Group 2 lesions: less commonly associated with HIV
- Group 3 lesions: possibly associated with HIV infection
What are the Group 1 lesions of HIV oral manifestations? (5)
- Candidosis
- Hairy leukoplakia
- HIV associated periodontal disease
- Kaposi’s sarcoma
- Non-hodgkin’s lymphoma
What types of candidosis are in the Group 1 oral manifestations of HIV group? (2)
- Erythematous
- Pseudomembranous
What is the treatment for candida infection in HIV? (1+3, 1+3)
Topical - Amphotericin – lozenges - Miconazole – oral gel - Nystatin – pastilles/suspension Systemic - Fluconazole - Itraconazole - Voriconazole
Describe HIV hairy leukoplakia including malignant potential, cause and treatment (6)
- Lesions are bilateral and corrugated
- Not premalignant
- Caused by Epstein-Barr virus
- Treatment:
- Generally does not require treatment
- May regress with acyclovir but usually returns on stopping therapy
What types of HIV associated periodontal diseases are in the Group 1 oral manifestations of HIV group? (4)
- Linear gingival erythema
- Necrotising ulcerative gingivitis – NUG
- Necrotising ulcerative periodontitis – NUP
- Necrotising ulcerative stomatitis – NUS
What is the aetiology of HIV – periodontal disease? (4)
- Spirochaetes
- Fusiform bacteria
- Anaerobic rods (similar to ANUG, and cancrum oris)
- In linear gingival erythema candida may also play a role
What is the management for HIV – periodontal disease? (1+5, 1+1)
Immediate: - Removal of necrotic bone and severely involved teeth - Debridement of necrotic tissue - 6% hydrogen peroxide irrigation of pockets/mouthwash - Antibiotics – metronidazole - OHI Long term: - Periodontal management
What is Kaposi’s sarcoma? (5)
- Neoplasm that is more likely to occur in AIDS patients
- Common site: mucosa of the hard palate
- Form of diffuse lymphoma rather than a discrete neoplasm
- Can be pigmented, non-painful, slightly nodular lesion of the mucosa with a characteristic histological appearance
- The herpes virus 8 (HHV-8) is now considered to a have a role in the aetiology of this sarcoma
What may the management for Kaposi’s sarcoma (HHV8) include? (4)
- Radiotherapy
- Systemic chemotherapy
- Intra-lesional chemotherapy
- Surgical excision
What is HIV – Non-Hodgkin’s lymphoma, how may it present? (2)
- Non-hodgkin’s lymphoma is commonly associated with HIV infection
- May present as a swelling or ulcerative lesion in the mouth
