[Clinical and research advances in oral AIDS].
HIV infection continues to spread throughout the world without any end insight, and is still the fastest increasing cause of mortality. The majority of HIV-infected patients have HIV-associated oral mucosal lesions at different stages of the disease. In many patients, oral lesions could be the first sign of their HIV infection. Therefore, knowledge of HIV infection has become a critically important requirement for professionals responsible for oral health care delivery and early detection of HIV infection. Oral candidiasis (OC), hairy leukoplakia (HL), and Kaposi sarcoma (KS) are the most common oral lesions strongly associated with HIV infection. Both pseudomembranous and erythematous OC occur in over 95% of HIV-infected patients throughout the oral cavity, highly related to a reversed CD4/CD8 cell ratio. Attached gingiva would be a unique site of OC, only occurring in HIV-infected patients. Because of decreased gastric acid secretion in most HIV-infected patients, fluconazole, the antifungal drug that can be absorbed easily despite the gastric pH change, would be the best choice for systemic antifungal treatment. HL primarily occurs in HIV-infected male patients on the lateral border of the tongue. However, similar-appearing changes can also occur in HIV-negative persons. HL is not related to precancerous leukoplakia or dysplasia. Our latest study indicated that the infection of Epstein-Barr virus (EBV) might not be the definitive criteria for the diagnosis of HL and that the reciprocal activation of EBV and HIV within the epithelium may be the critical event in the development of HL. Our study demonstrated that CD4-bearing oral mucosal Langerhans cells (LC) could be the target of HIV infection, the effector to alter LC number and its antigen processing capability, as well as the vector to pass the virus to submucosal memory T cells, which would be responsible for the second pathway of HIV transmission through mucosal contact with HIV. HIV-associated depletion of LC would lead to impairment of the oral mucosal surveillant system, resulting in opportunistic oral mucosal lesions, such as OC and HL. KS has been the most common tumor associated with HIV infection and has been one of the AIDS defining diseases. The latest study indicated that this tumor is related to opportunistic infection of human herpes simplex virus 8. Because of its reactive type nature clinically and histologically, KS has now been considered a pseudomalignancy. Intralesional injection of cytotoxic drugs has been effective in treatment. Since HIV-infected patients have demonstrated a higher propensity for developing allergic and adverse reactions to antibiotics, bleeding tendency and slow wound healing after dental surgery, decreased levels of neutrophil counts, and xerostomia, a modified dental therapy would be essential for management of HIV-infected dental patients. In addition, concerns about HIV transmission from patient to dentist, dentist to patient, and between patients should be clarified.
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