HIV Infection and the Oral Manifestations of HIV Flashcards Preview

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Flashcards in HIV Infection and the Oral Manifestations of HIV Deck (23)
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1
Q

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)

A
  • People living with HIV - 39.5million
  • Newly infected with HIV - 4.3million
  • Deaths due to AIDS - 2.9million
2
Q

What is HIV? (12)

A
  • 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)
3
Q

What are the stages of HIV infection? (4, 1+4, 1+3)

A

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

4
Q

How is Human immunodeficiency virus (HIV) diagnosed? (1, 1+3, 1+2)

A
  • History and clinical features
  • General lab investigations
  • Lymphopenia
  • CD4 cound reduced
  • CD4/CD8 ratio reduced
  • HIV testing (after counselling)
  • HIV antibodies
  • HIV antigens
5
Q

What are the three groups of HIV oral manifestations? (3)

A
  • Group 1 lesions: strongly associated with HIV infection
  • Group 2 lesions: less commonly associated with HIV
  • Group 3 lesions: possibly associated with HIV infection
6
Q

What are the Group 1 lesions of HIV oral manifestations? (5)

A
  • Candidosis
  • Hairy leukoplakia
  • HIV associated periodontal disease
  • Kaposi’s sarcoma
  • Non-hodgkin’s lymphoma
7
Q

What types of candidosis are in the Group 1 oral manifestations of HIV group? (2)

A
  • Erythematous

- Pseudomembranous

8
Q

What is the treatment for candida infection in HIV? (1+3, 1+3)

A
Topical 
-	Amphotericin – lozenges 
-	Miconazole – oral gel 
-	Nystatin – pastilles/suspension 
Systemic 
-	Fluconazole 
-	Itraconazole 
-	Voriconazole
9
Q

Describe HIV hairy leukoplakia including malignant potential, cause and treatment (6)

A
  • 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
10
Q

What types of HIV associated periodontal diseases are in the Group 1 oral manifestations of HIV group? (4)

A
  • Linear gingival erythema
  • Necrotising ulcerative gingivitis – NUG
  • Necrotising ulcerative periodontitis – NUP
  • Necrotising ulcerative stomatitis – NUS
11
Q

What is the aetiology of HIV – periodontal disease? (4)

A
  • Spirochaetes
  • Fusiform bacteria
  • Anaerobic rods (similar to ANUG, and cancrum oris)
  • In linear gingival erythema candida may also play a role
12
Q

What is the management for HIV – periodontal disease? (1+5, 1+1)

A
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
13
Q

What is Kaposi’s sarcoma? (5)

A
  • 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
14
Q

What may the management for Kaposi’s sarcoma (HHV8) include? (4)

A
  • Radiotherapy
  • Systemic chemotherapy
  • Intra-lesional chemotherapy
  • Surgical excision
15
Q

What is HIV – Non-Hodgkin’s lymphoma, how may it present? (2)

A
  • Non-hodgkin’s lymphoma is commonly associated with HIV infection
  • May present as a swelling or ulcerative lesion in the mouth
16
Q

What is the management of HIV – Non-Hodgkin’s lymphoma? (2)

A
  • Radiotherapy

- Chemotherapy

17
Q

What are the HIV oral manifestations Group 2 (less commonly associated with HIV) lesions?

A
  • Atypical oropharygeal ulceration
  • Idiopathic thrombocytopenic purpura
  • Salivary gland disorder
  • Viral infection other than EBV
18
Q

What types of salivary gland disorder can occur in HIV oral manifestations? (2)

A
  • Dry mouth, decreased salivary flow rate

- Swelling of major salivary glands

19
Q

What types of viral infections other than EBV can occur in HIV oral manifestations? (4)

A
  • Cytomegalovirus – severe or atypical oral ulcers
  • Herpes simplex – severe secondary Herpes
  • Human papillomavirus – multiple warts
  • Herpes (varicella) zoster – severe shingles
20
Q

What are the HIV oral manifestations Group 3 (possibly associated with HIV infection) lesions? (3, 1+2)

A
  • Oral bacteria infections other than periodontal disease
  • Fungal infections other than candidiasis
  • Melanotic hyperpigmentation
  • Neurological disturbances
  • Trigeminal neuralgia
  • Facial palsy
21
Q

What is the management for Human Immunodeficiency Virus (HIV)? (1+(1+3,2)2)

A

Systemic treatment:
- Modern combination anti-retroviral therapy
- Often called HAART (highly active anti-retroviral therapy)
- Very effective at preventing progression to AIDS
- Reduces immunosuppression and associated opportunistic infections and tumours
- Prophylactic treatment for opportunistic infections
- Provided by HIV clinics, GUM clinics, GMP etc
Dental care and OHI provided by GDP
Oral manifestations – treat as per lesion requires

22
Q

How should a needle stick/occupational exposure be dealt with in terms of first aid? (4)

A
  • Encourage bleeding under running water
  • Apply or scrub with antiseptic then cover wound
  • Irrigate exposed eyes, nasal or oral mucosa
  • Record details in accident book
23
Q

32) How should a needle stick/occupational exposure be managed post first aid?

A

Report exposure to Occcupational health, GUM clinic or GMP. They will arrange:

  • Counselling re:
  • Possible treatment with AZT
  • Confidential HBV and possible HIV testing
  • Risk assessment:
  • Identification of source patient
  • Clinical and serological evaluation of HIV/HBV status with patients permission
  • Follow up:
  • Hepatitis B status testing, vaccination and treatment
  • HIV testing