The significance and management of periodontal lesions in HIV infection.
It is now almost 20 years since we reported the existence of a previously unknown lesion, oral hairy leukoplakia, and its unexpected nature as the only human disease in which there is prolific replication of the gamma-herpesvirus, Epstein-Barr virus (EBV). Since then, it has become clear that, in the HIV-infected population, oral lesions are of particular significance. Their presence in individuals of unknown HIV serostatus is highly suggestive of HIV infection, while in people who are known to be HIV-infected, the development of oral candidiasis or hairy leukoplakia--often the very first lesions to occur--indicates that the battle between HIV virion production and destruction of immunologically important cells on, versus replacement of those cells has shifted in favour of HIV. These observations have led to the almost universal inclusion of oral lesions in staging and classification schemes for HIV infection. Recently, lower frequencies of oral disease have been seen in those on HIV therapy, except that oral warts may become more common as the viral load falls and CD4 count rises.


OBJECTIVE
To review the significance and management of periodontal lesions seen in HIV infection.


METHODS
Traditional review.


RESULTS
HIV-associated periodontal lesions may be categorized as unusual forms of gingivitis, necrotizing periodontal diseases and exacerbated periodontitis. These lesions are significant in the extent to which they mark the underlying HIV disease and have service planning implications. Only limited data are available to inform guidelines for the management of individual patients.


CONCLUSIONS
Research of the effectiveness of interventions for HIV-associated periodontal lesions is needed.
Robinson
Peter G
PG
Department of Dental Public Health, GKT Dental Institute, London, UK. PeterGRobinson@btinternet.com
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000517:prevention & control; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002180:Candidiasis, Oral / Q000150:complications / Q000517:prevention & control; D018450:Disease Progression; D005891:Gingivitis / Q000150:complications; D005892:Gingivitis, Necrotizing Ulcerative / Q000150:complications; D015658:HIV Infections / Q000150:complications*; D006679:HIV Seropositivity / Q000175:diagnosis; D006801:Humans; D017733:Leukoplakia, Hairy / Q000150:complications / Q000517:prevention & control; D009059:Mouth Diseases / Q000150:complications; D010510:Periodontal Diseases / Q000150:complications* / Q000628:therapy; D010518:Periodontitis / Q000150:complications; D012008:Recurrence; D014860:Warts / Q000150:complications
D019380:Anti-HIV Agents