HIV lesions

Question 1

where is the main reservoir of HIV?

Answer 1

East and Southern Africa

Question 2

how many genes does HIV contain and name a few

Answer 2

• 9
• 3 structural - gag, pol, rev
• 6 non-structural/regulatory

Question 3

what enzymes does HIV contain? (4)

Answer 3

• reverse transcriptase
• integrase
• protease
• ligase

Question 4

describe briefly the replication cycle of HIV

Answer 4

1 binding by gp120 and gp41 to CD4 and co receptro (CCR5 or CXCR4)
2 fusion and entry by endocytosis
3 reverse transcription of viral RNA = SS DNA –> DS DNA
4 integration of DS viral DNA into host DNA
5 transcription, translation by host
6 assembly of virus
7 budding

Question 5

what types of cells does HIV affect? (3)

Answer 5

• CD4+ Th cells
• macrophages
• dendritic cells

Question 6

how is HIV transmitted?

Answer 6

body fluids only

Question 7

describe the natural history of infection and give the relative CD4 counts and viral loads

Answer 7

5 continuous stages:
1 primary HIV infection = rapid CD4 decrease and high VL
2 early stage = CD4 >500, low VL
3 middle stage = lower CD4
4 advanced stage = lower CD4, high VL
5 late stage = CD4 <50, very high VL

Question 8

what is acute seroconversion syndrome? (what, time, s/s)

Answer 8

• primary HIV infection, days-weeks post-exposure
• most develop influenza-like illness (non-specific symptoms)
  – fever, malaise, lymphadenopathy, myalgia, pharyngitis, rash, oral ULCERS

Question 9

what are the different groups of HIV oral manifestations? (3)

Answer 9

• group 1 = strongly associated with HIV
• group 2 = less commonly associated
• group 3 = lesions seen in HIV inection, rare

Question 10

what is seen in group 1 HIV oral manifestations? (4)

Answer 10

(strongly associated with HIV)
- oral hairy leukoplakia
- rapidly progression periodontal disease
- Kaposi’s sarcoma
- non-Hodgkin’s lymphoma

Question 11

what is seen in group 2 HIV oral manifestations? (4)

Answer 11

(less commonly associated with HIV)
- ulceration
- salivary gland disease
- thrombocytopaenic purpura
- viral infections (HSV, HPV, VZV, CMV)

Question 12

what is seen in group 3 HIV oral manifestations? (3)

Answer 12

(rare, seen in HIV infection)
- drug reactions
- fungal, viral infections
- neurological disturbances

Question 13

what is one of the most frequent oral manifestations of untreated HIV?

Answer 13

oral hairy leukoplakia with oral candidiasis

Question 14

how may periodontal disease present in HIV-infected pts? (4)

Answer 14

• painful
• disproportionate to OH/plaque levels
• localised
• rapid alveolar bone loss
  (linear gingival erythema, NPDs)

Question 15

management of rapidly progressing periodontal disease in HIV-infected pts (4)

Answer 15

• manage HIV infection (antiviral therapy)
• OHI, debridement
• CHX 0.2% mouthwash
• metronidazole

Question 16

treatment of Kaposi’s sarcoma in HIV-infected pts

Answer 16

• ART (prevention and treatment_
• +/- chemotherapy

Question 17

describe non-Hodgkin’s lymphoma in HIV-infected pts (presentation, Ix)

Answer 17

• rapidly enlarging masses with bone destruction
• esp gingivae, fauces
• with systemic symptoms = fever, night sweats, lymphadenopathy, weight loss, fatigue
• biopsy/histological diagnosis

Question 18

list the different drug classes used to treat HIV (5)

Answer 18

• entry inhibitors
• nucleoside reverse transcriptase inhibitors
• non-nucleoside reverse transcriptase inhibitors
• integrase inhibitors
• protease inhibitors

Question 19

what are the BHIVA guidelines regarding HIV treatment? (2)

Answer 19

• treatment-naïve = start ART containing at least 2 nucleoside reverse transcriptase inhibitors AND one other drug type
• all HIV pts should consider starting ART regardless of CD4 count or VL

Question 20

how does ART affect the orofacial region? (6)

Answer 20

• decreased prevalence in most HIV-associated oral lesions (reported exceptions with papilloma and HIV-related salivary gland disease)
• adverse effects:
  – lipodystrophy
  – hyperpigmentation
  – oral ulceration
  – xerostomia
  – hypersensitivity reactions (SJS, TEN)

Question 21

what to do if you get a sharps injury? (2)

Answer 21

• refer to occupational health for risk assessment
• early prophylaxis (PEP) if high risk (type of injury, type of fluid, source pt)

Question 22

what is PrEP?

Answer 22

• pre-exposure prophylaxis
• consistent use can decrease transmission through sex by 90%