AIDS or acquired immune deficiency syndrome is fatal disease caused by human immunodeficiency virus (HIV).

Ways of transmission

• It is a sexually transmitted disease (STD) – in  90 % of the cases it is transmitted during sexual contact if any 1 partner is carrying the virus.
• It can be caused if  syringes are reused for all patients, during blood transfusion,  drug users who intake drugs intravenously or during organ transplant.
• It can be transmitted from an HIV positive mother to child .
• Doctors , nurses and health acre workers are at a high risk of contracting the disease .
• It can also be transmitted through saliva but the possibility is very rare.

Oral signs and symptoms of HIV are

• In HIV the immune system goes down drastically and so a lot of other infections affect the individual, they are called opportunistic infection.
• Infection could be bacterial, fungal, viral etc.
• Most common fungal disease like candidiasis.
• Bacterial disease like HIV gingivitis, HIV periodontitis, necrotising gingivitis.
• Viral infection like herpes simplex, varicella zoster, Epstein barr virus causing hairy leucoplakia.
• Neoplasms like kaposi’s sarcoma.
• Some of the less common infections seen in HIV patients are Aspergillosis, Histoplasmosis, Non – Hodgkin’s lymphoma, Squamous cell carcinoma. (below mentioned are most commonly seen infections in HIV patients)

FUNGAL INFECTION

CANDIDIASIS –

Bacterial infection

• Necrotizing ulcerative gingivitis- there is spontaneous bleeding from the gums. Large painful ulcers are seen on the gums leading to inflammation of gums. Similar ulcers are also seen at the gum margins and in the gum area between the teeth . Patient complains of severe pain. These ulcers heal but the gums have a cratered appearance.
• Necrotizing ulcerative periodontitis -there is continuous loss of the bone that supports the teeth and also of the sift tissue. This will laed to loosening of teeth and they will finally fall out.

Treatment

• Necrotic tissue can be removed and irrigated with povidone iodine.
• Oral hygiene should be maintained meticulously by doing periodic scaling and brushing flossing and mouthwash.
• Antibiotics can be given.

Viral infection

1. Herpes simplex infection – it occurs mainly as herpes labialis . These lesions occur on the lip and contain a vesicle (i.e it is like a sac or a cavity). They heal in 7 to 10 days.

Treatment

• Antiviral drugs like systemic Acyclovir can be given.
• Symptomatic treatment should be given.

• Herpes zoster infection –it is seen mainly in a HIV person . these vesicles are placed unilaretally . These vesicles break and  form a scab. They are present for a long period of time.

Treatment

Antiviral drugs like Acyclovir should be given intravenously every 8 hours fot around 12 to 15 days.

Epstein- barr virus causing oral hairy leukoplakia

• Oral hairy leukoplakia are hair like lesions present on the lateral surface of the tongue . it is very common in HIV patients. The cause of hairy leukoplakia is not yet known.
• They appear on the lateral border of the tongue either unilaterally or bilaterally.
• It has an irregular appearance and the white patch cannot be rubbed off.
• These irregular areas are projections seen on the tongue so they look like hair.
•  It is sometimes seen on the upper portion of the tongue, the inner surface of the cheek, soft palate.

Treatment

• Antiviral drugs include high dose of Acyclovir to be given for 2 to 3 weeks.
• Drugs like Zidovudine considerably help in reducing the occurance of hairy leukoplakia.
• Topical application of drugs like clotrimazole, nystatin, ketoconazole.

Neoplasm like Kaposi’s sarcoma

It is a tumour which occurs very commonly in HIV patients.

Features of kaposi’s sarcoma

• It is seen in the head and neck region . commonly involves the lymph nodes, lung, liver , gastrointestinal tract, pancreas, spleen.
• In the mouth the most common site is the hard palate . But it can also occur on the gums, soft palate, buccal mucosa. It appears asa a red or purplish lesion which can be either fkat or raised. It can be either present as single lesion or as a multiple lesion. These lesion enlarge in size and form ulcers.
• They vary in size from a few millimeters or a centimeter.
• These lesions are quite painful , patient complains of difficulty in eating and talking and swallowing.
• In some cases the there is necrosis of the tissue.
• If these lesions invade the bone of the teeth it may lead to mobility of teeth.

Treatment

• Proper maintainance of oral hygiene.
• Systemic chemotherapy.
• Removal of the lesion by surgery or LASER or cautery.
• Radiation therapy.
• Antiretroviral drugs.