Human Immunodeficiency Virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS) are systemic conditions with significant oral manifestations, many of which may appear before systemic symptoms.
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This article reviews the oral manifestations of HIV/AIDS, organized from early-stage lesions to those typically associated with advanced immunosuppression.
✅ Early Oral Manifestations of HIV Infection
Early lesions often appear when immune suppression begins and may be the first clinical indicator of HIV infection.
➤ Oral Candidiasis
▪️ Most common oral manifestation of HIV
▪️ Appears as pseudomembranous (white plaques), erythematous, or angular cheilitis
▪️ Easily detachable plaques that leave an erythematous surface
▪️ Strongly associated with declining CD4+ cell counts
➤ Linear Gingival Erythema
▪️ Persistent red band along the gingival margin
▪️ Minimal plaque accumulation
▪️ Poor response to conventional periodontal therapy
▪️ Considered an early immunologic alteration
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As immune function declines, more aggressive and destructive lesions may develop.
➤ Necrotizing Ulcerative Gingivitis (NUG) and Periodontitis (NUP)
▪️ Rapid periodontal tissue destruction
▪️ Severe pain, spontaneous bleeding, and fetid odor
▪️ Loss of attachment and alveolar bone
▪️ Strongly linked to immunosuppression
➤ Oral Hairy Leukoplakia
▪️ White, corrugated lesions on the lateral borders of the tongue
▪️ Caused by Epstein–Barr virus
▪️ Non-removable and usually asymptomatic
▪️ Indicates moderate to advanced immunodeficiency
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These lesions are typically associated with severe immune compromise and advanced disease stages.
➤ Kaposi’s Sarcoma
▪️ Vascular neoplasm associated with Human Herpesvirus 8 (HHV-8)
▪️ Appears as purple, red, or brown macules or nodules
▪️ Common sites: palate, gingiva, tongue
▪️ May interfere with speech and mastication
➤ Non-Hodgkin’s Lymphoma
▪️ Rapidly enlarging ulcerated masses
▪️ Commonly affects gingiva, palate, or jaw bones
▪️ Aggressive behavior and poor prognosis
➤ Chronic Viral Infections
▪️ Recurrent herpes simplex ulcers
▪️ Cytomegalovirus-related oral ulcers
▪️ Persistent, painful, and slow healing
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Oral lesions in HIV/AIDS patients are not merely local findings; they provide insight into systemic immune status, treatment adherence, and disease progression. Dentists play a crucial role in early referral, diagnosis, and interdisciplinary care.
📊 Comparative Table: Routes of HIV Transmission
| Mode of Transmission | Description | Preventive Measures |
|---|---|---|
| Unprotected Sexual Contact | Exposure to infected semen or vaginal fluids | Condom use, PrEP, regular testing |
| Blood Exposure | Sharing contaminated needles or transfusions | Sterile instruments, screened blood products |
| Vertical Transmission | Mother-to-child during pregnancy or breastfeeding | Antiretroviral therapy during pregnancy |
| Occupational Exposure | Needlestick injuries in healthcare settings | Universal precautions and post-exposure prophylaxis |
The progression of oral manifestations in HIV/AIDS closely parallels immune deterioration. Early recognition of oral lesions allows for prompt diagnosis and initiation of antiretroviral therapy, significantly improving prognosis. With modern treatment, many classic lesions have decreased in prevalence; however, they remain clinically relevant, particularly in undiagnosed or untreated individuals.
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Oral manifestations are key indicators of HIV infection and disease progression. From early fungal lesions to advanced neoplastic conditions, the oral cavity provides valuable diagnostic information. Early detection and appropriate management by dental professionals contribute significantly to improved patient outcomes and systemic disease control.
🎯 Recommendations
▪️ Perform thorough oral examinations in all patients
▪️ Consider HIV testing referral when suggestive lesions are present
▪️ Maintain strict infection control protocols
▪️ Collaborate with medical professionals for comprehensive care
▪️ Educate patients on oral hygiene and routine dental visits
📚 References
✔ Greenspan, J. S., & Greenspan, D. (2019). Oral manifestations of HIV infection. Clinical Infectious Diseases, 68(6), 993–998. https://doi.org/10.1093/cid/ciy556
✔ Patton, L. L., Epstein, J. B., & Kerr, A. R. (2020). Adjunctive oral diagnosis in HIV disease. Journal of the American Dental Association, 151(3), 170–178. https://doi.org/10.1016/j.adaj.2019.11.004
✔ World Health Organization. (2023). HIV-associated oral lesions and conditions. WHO Press.
✔ Shiboski, C. H., et al. (2021). Oral disease burden in HIV patients. Oral Diseases, 27(1), 3–12. https://doi.org/10.1111/odi.13441
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