The HIV Virus
HIV (human immunodeficiency virus) is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases. HIV belongs to a class of viruses called retroviruses and a subgroup of retroviruses known aslentiviruses or “slow” virus.
First identified in 1981, HIV is among the leading causes of death worldwide and it causes more deaths than any other infectious diseases, if left untreated, HIV can lead to AIDS (acquired immunodeficiency syndrome). AIDS is the last stage of HIV infection that occurs when the body’s immune system is badly damaged by the virus.
Transmission Of HIV
HIV is a sexually transmitted disease. During sexual contact, the virus can cross the mucosal barrier of the vagina, vulva, penis, and rectum by first encountering immune (dendritic) cells that carry the virus across the mucosa. HIV is also spread by contact with infected blood, most often through the practice of reusing or sharing syringes and needles with drugs. There is a risk of transmitting HIV from a pregnant mother to the fetus or newborn during pregnancy, during delivery, or by breastfeeding. The occupational risk to healthcare workers also exists, mainly through an accidental needle stick or mucosal splash with contaminated blood.
The US Food and Drug Administration (FDA) has approved enzyme-linked immunoassay (ELISA) as screening blood tests for HIV. The Western blot test is usually done to confirm the diagnosis.
The symptoms of HIV include a fever that lasts for more than 10 days, being tired all the time, excessive sweating at night, weight loss of more than 10 kgs with no obvious reasons, shortness of breath and long lasting diarrhea.
Oral Manifestations Of HIV
Oral lesions are among the earliest manifestation of HIV and are important in early diagnosis and monitoring for progression of the disease.
Erythematous candidiasis [fig 1]
This is the most common fungal infections in HIV positive patients. They are flat diffuse, red patches. These can occur on any site in the oral cavity but are more commonly seen on the palate and tongue. The most common clinical symptoms are vague burning pain. Sometimes it can be covered by a white slough that can be rubbed off.
Pseudomembranous candidiasis [fig 2]
They are soft, white adherent patches on the oral mucosa. The most common sites are the roof of the mouth, retromolar area and mesiobuccal fold. They appear as pearly white or bluish-white plaques which resemble cottage cheese or curdled milk. The common symptoms are rapid onset of bad taste and discomfort from spicy food. Loosely attached to the mucosa, when wiped off it reveals a red erythematous area with or without bleeding.
Angular cheilitis [fig 3]
It is an inflammation and small cracks of the skin and labial mucous membrane at the angles of the mouth. They appear as cracks or fissures with redness and bleeding. They are painful, itchy and people often describe a burning sensation.
Oral hairy leukoplakia[ [fig 4]
It is a white patch on the side of the tongue with a corrugated with tiny hairy like projections. It may also occur on the lateral surface of the tongue, although rarely it may occur on the buccal mucosa, soft palate, pharynx, or esophagus. It occurs most commonly in HIV positive patients. There are no symptoms associated with the lesion. The white lesions cannot be scraped off, is benign and do not require any treatment.
Linear gingival erythema[ fig 5 ]
A condition in which the edge of the gums near the teeth become red and inflamed. It is also referred to as HIV gingivitis. It is generalized or localized with a persistent red linear band (2-3mm) and can easily bleed There is no evidence of ulceration. They undergo spontaneous remission.
Necrotizing gingivitis [fig 6]
It is a common infection of the oral cavity with a sudden onset. The main features are painful, bleeding gums and ulceration in the sections of gum between adjacent teeth. It is often accompanied by severe gum pain, profuse bleeding ulcerations, foul breath, bad taste, malaise, and fever. Untreated infections may spread to neighboring cheeks, lips, or bones of the jaw.
The above article is contributed by the Department of Oral Pathology & Microbiology, Yenepoya Dental College under the Yenepoya (Deemed to be University ) established in the year 1992, with its robust alumni of 3000 Undergraduates and 67 Postgraduates students and research scholars has many accolades and achievements to its credit. It strives to provide state of art Oral diagnostics and Molecular Pathology while excelling in research activities and instilling a holistic approach in dental education among students. Department contributes its expertise in fostering interdisciplinary collaboration and providing exemplary education and scientific research.