a i d s

1. a i d s dr shabeel pn

2. ORAL MANIFESTATION OF HIV INFECTIONS • What is the importance ? • Oral cavity can be easily examined • Common • Early recognition diagnosis and treatment may reduce morbidity • Early diagnostic indicator • May change the staging • Predictor of progression of HIV done

3. Fungal lesions Viral Bacterial Neoplastic Minor oral ulcers

4. FUNGAL LESIONS • Oral Candidiasis • Candida albicani • Candida glabrata and C.tropicalis • Common oral manifestation of acute stage of HIV infection

5. Occur with falling CD4 + T cell count in middle and late stages of HIV • Other predisposing factors, are infancy, old age, antibiotic therapy, steroids and other immunosuppressive drugs, xerostamia, anaemia, endocrine disorders, primary and acquired immunodeficiency.

6. CLINICAL FEATURES • Burning mouth, problems eating spicy food and changes in taste. • Clinical appearance varies • Common are pseudomembranous and erythematous candidiasis

7. HISTOPLASTOMIES • Appear as oral ulcers • Diagnosis requires biopsy • Cryptococcus neoformans • Ulcerated mass in the hard palate. Biopsy of palatal ulcer is diagnostic.

9. VIRAL LESIONS • Painful persistent large intraoral ulcers • Buccal/ labial mucosa 27%, tongue 25%, gingiva – 18%

10. Recurrent herpes simplex (H.Labialis, cold sores) • Develop on the lips • Intraorally in the keratinised mucosa of palate and gingiva. • Begins as a burning sensation followed by small coalseing vesicles. • Ulcer surrounded by erythematous halo • No scan formation • Importance – Patients with advanced HIV disease may present several recurrence a year especially characterized by large confluent and extremely painful ulceration.

12. HERPES ZOSTER • Painful oral lesion or tooth ache • Usually unilateral • Follow the distribution of maxillary and /or mandibular branches of trigeminal nerve.

13. Human Papilloma • Oral wart • Papilloma

14. CYTOMEGALOVIRUS • Confused with aphthous ulcers, necrotizing ulcerative periodontitis and lymphoma • Aphthous ulcer • CMV Diagnosis by biopsy and immunohistochemistry

16. HAIRY LEUKOPLAKIA • Non movable corrugated or hairy white lesion on the lateral margins of tongue. • Occurs in 20% of person with asymptomatic HIV infection • Becomes more common as the CD4+T cell count falls • Non HIV patients who are affected are recipients of bone marrow, cardiac and renal transplants

18. BACTERIAL INFECTION Periodontal Disease Necrotising ulcerative periodontitis - Rapid and severe course Linear gingival erythema – relative mild form

19. MYCOBACTERIUM AVIUM INTRACELLULARE • Palatal and gingival granulomatous masses • Diagnosed by AFB staining of biopsy specimens

20. NEOPLASTIC LESION • This may occur intraorally either alone or association with skin and disseminated lesion. • Common in men • First manifestation of late stage of HIV

21. DIFFERENTIAL DIAGNOSIS • Vascular lesion – haematoma, haemangioma • Pyogenic granuloma • Bacillary angiomatosis • Oral melanotic macules • No bleeding associated with a biopsy of oral KS aspiration prior to biopsy may be useful to rule out haemangioma. Sudden appearance is characteristic.

22. LYMPHOMA • Firm painless swelling that may be ulcerated • Occur anywhere in the oral cavity • Soft tissue involvement • Bony involvement

23. DIFFERENTIAL DIAGNOSIS • Confusion with major aphthous ulcers and rarely pericoronitis associated with an erupting third molar • Diagnosis made by histologic examination of biopsy specimen.

24. OTHER ORAL LESIONS • Recurrent Aphthous ulcers (RAU) • Cause unknown – Stress and unidentified infectious agents • Minor RAU – Well circumscribed with erythematous margin. • Solitary lesion of 0.5-1cm • Herpetiform type RAU- Clusters of small ulcers

25. Major RAU – Extremely large necrotic ulcer 2-4cm • Idiopathic thrombocytopenic purpura may first manifest as oral lesion in HIV infected patients • Xerostomia

26. Oral manifestation in children with AIDS • Children infected with HIV develop severe immunosuppression very early • Earlier than adults • Fungal infections are more

27. DIAGNOSIS • Detection of antiviral protein • CD4+ T Cell count – oral abnormalities result from changes in the immune status of HIV carrier – Due to reduction in the number of CD4 + T cells and / or modification of CD4 / CD8 ratio. • Increased T8 cells in germinal centres.

28. TREATMENT • Most of the opportunistic infections are incurable. But by aggressively treating the acute disease, the infection can be controlled and suffering of patient decreased.

29. Cryptococcus – Amphotericin B 0.5- 0.8mg/kg/d iv • Bacterial- Ampicillin • Trimethoprim- Sulphamethoxazole • Chloramphenicol • Ceftriaxone • Viral - Ganciclovir IV

30. PREVENTION Teach ABC of AIDS prevention Abstrain Be faithful Use Condom Dental Surgeons – High risk category - use gloves, Goggles, Facemask. Every patient is HIV positive until other wise proved.

31. THANK YOU