Oral Manifestation of HIV Infection

The HIV infection has a multitude of effects on the human body. A common area which is affected by the virus is the oral cavity. This article discusses three disease of the oral cavity that is a result of an HIV infection.

Oral Hairy Leukoplakia

Oral hairy leokoplakia (OHL) primarily occurs in persons with HIV. It is commonly found on lateral borders of tongue, dorsum of tongue, buccal mucosa, floor of the mouth, retromolar region, and soft palate. It can have a bilateral distribution extending to the ventral surfaces of the tongue. OHL is often times asymptomatic. It has a poorly demarcated keratotic area ranging from few millimeters to several centimeters.

A histopathological examination shows a hyperparakertotic surface with projection. Acanthosis and balloon cells representing koilocytes are also present. Fortunately, dysplasia is usually not a feature.

OHL has been associated with the Epstein Barr Virus. Due to its clinical appearance, a biopsy should be taken to rule out other pathological diseases. The differential diagnosis includes: dysplasia, carcinoma, keratosis, lichen planus, tobacco-related leukoplakia, psoriasiform lesions, and hyperplastic candidiasis

Oral Candidiasis

Oral candidiasis is a fungus found in normal oral flora which can proliferate on surface of oral mucosa. It is associated with Candida albicans and is the most common oral lesion in HIV patients (90%). A major factor associated with growth is diminished host resistance.

Pseudomembranous candidiasis presents as painless or slightly sensitive white lesion, that is easily scraped and separated from surface of mucosa. It most often found on the hard palate, soft palate, buccal and labial mucosa. Erythematous candidiasis presents as component of pseudomembranous type. It appears as red patches on the buccal or palatal mucosa or associated with depapillation of tongue.

Hyperplastic candidiasis the least common form and is seen on the buccal mucosa and tongue. A diagnosis is made by a biopsy or smear. A positive biopsy will show hyphae and yeast. Generally, it responds well to antifungal therapy. 30% of AIDS related candidiasis relapses in 4 weeks. 60 to 80% in 3 months and 10% can become resistant

Kaposi's Sarcoma

Kaposi's Sarcoma (KS) is a rare, multifocal vascular neoplasm. The cause is unknown however it has been associated to the HHV-8 virus. HIV infected individuals are 7000 fold more likely to develop KS. An etiologic association has not been established. In a recent study, 53 of 54 AIDS patients with KS also had HHV-8.

The classic form of KS is a localized slowly growing lesion. In HIV patients, a much more aggressive lesion develops. A majority of these lesions develop on the oral mucosa, particularly on the palate and gingiva. Early stages are painless with reddish purple macules of mucosa. As it progresses, the lesions become more nodular, usually brown, blue or purple in color.

A histological evaluation has four components: endothelial cell proliferation with formation of atypical vascular channels; extravascular hemorrhage with hemosiderin depositions, spindle cell proliferation in association with atypical vessels, mononuclear inflammatory infiltrate. The differential diagnosis includes pyogenic granuloma, hemangioma, atypical hyperpigmentation, sarcoidosis, bacillary angiomatosis, angoisarcoma, pigmented nevi, cat scratch disease.

Treatment of Kaposi Sarcoma is vast and can potentially include chemo and radiation therapy. A consultation with a radiation oncologist is usually obtained. Depending on the severity of the disease, control of the HIV infection can have a dramatic effect on the Kaposi Sarcoma infection.