Current HIV/AIDS Reports

, Volume 5, Issue 1, pp 5–12

Oral manifestations associated with HIV infection



Oral lesions are among the early signs of HIV infection and can predict progression to AIDS. The lesions commonly associated with the infection include oral candidiasis, herpes simplex infection, oral Kaposi’s sarcoma, oral hairy leukoplakia, parotid gland enlargement, gingival diseases, xerostomia, and recurrent oral ulcerations. The introduction of highly active antiretroviral therapy has changed the epidemiology of some of the oral diseases associated with HIV infection. This review discusses the oral manifestations associated with HIV disease, the change in the pattern of the disease, and some research questions that need more emphasis from the research community.


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References and Recommended Reading

  1. 1.
    Calderone RA, Fonzi WA: Virulence factors of Candida albicans. Trends Microbiol 2001, 9:327–335.PubMedCrossRefGoogle Scholar
  2. 2.
    Leigh JE, Shetty K, Fidel PL Jr: Oral opportunistic infections in HIV-positive individuals: review and role of mucosal immunity. AIDS Patient Care STDS 2004, 18:443–456PubMedCrossRefGoogle Scholar
  3. 3.
    Reznik DA: Oral manifestations of HIV disease. Top HIV Med 2006, 13:143–148.Google Scholar
  4. 4.
    Greenspan D, Greenspan JS, Conant M, et al.: Oral “hairy” leukoplakia in male homosexuals: evidence of association with both papillomavirus and a herpes-group virus. Lancet 1984, 2:831–834.PubMedCrossRefGoogle Scholar
  5. 5.
    Ammatuna P, Campisi G, Giovannelli L, et al.: Presence of Epstein-Barr virus, cytomegalovirus and human papillomavirus in normal oral mucosa of HIV-infected and renal transplant patients. Oral Dis 2001, 7:34–40.PubMedGoogle Scholar
  6. 6.
    Shiboski CH, Hilton JF, Neuhaus JM, et al.: Human immunodeficiency virus-related oral manifestations and gender. A longitudinal analysis. Arch Intern Med 1996, 156:2249–2254.PubMedCrossRefGoogle Scholar
  7. 7.
    Ammatuna P, Capone F, Giambelluca D, et al.: Detection of Epstein-Barr virus (EBV) DNA and antigens in oral mucosa of renal transplant patients without clinical evidence of oral hairy leukoplakia (OHL). J Oral Pathol Med 1998, 27:420–427.PubMedCrossRefGoogle Scholar
  8. 8.
    Sitki-Green, D, Edwards RH, Webster-Cyriaque J, Raab-Traub N: Identification of Epstein-Barr virus strain variants in hairy leukoplakia and peripheral blood by use of a heteroduplex tracking assay. J Virol 2002, 76:9645–9656.PubMedCrossRefGoogle Scholar
  9. 9.
    Cattaneo C, Facchetti F, Re A, et al.: Oral cavity lymphomas in immunocompetent and human immunodeficiency virus infected patients. Leuk Lymphoma 2005, 46:77–81.PubMedCrossRefGoogle Scholar
  10. 10.
    Iamaroon A, Pongsiriwet S, Mahanupab P, et al.: Oral non-Hodgkin lymphomas: studies of EBV and p53 expression. Oral Dis 2003, 9:14–18.PubMedCrossRefGoogle Scholar
  11. 11.
    Dodd CL, Greenspan D, Schiødt M, et al.: Unusual oral presentation of non-Hodgkin’s lymphoma in association with HIV infection. Oral Surg Oral Med Oral Pathol 1992, 73:603–608.PubMedCrossRefGoogle Scholar
  12. 12.
    Gates AE, Kaplan LD: AIDS malignancies in the era of highly active antiretroviral therapy. Oncology (Williston Park) 2002, 16: 657–665, 668–670.Google Scholar
  13. 13.
    Thirlwell C, Sarker D, Stebbing J, Bower M: Acquired immunodeficiency syndrome-related lymphoma in the era of highly active antiretroviral therapy. Clin Lymphoma 2003, 4:86–92.PubMedGoogle Scholar
  14. 14.
    Ramirez-Amador V, Esquivel-Pedraza L, Lozada-Nur F, et al.: Intralesional vinblastine vs 3% sodium tetradecyl sulfate for the treatment of oral Kaposi’s sarcoma. A double blind, randomized clinical trial. Oral Oncol 2002, 38:460–467.PubMedCrossRefGoogle Scholar
  15. 15.
    Levine AM, Tulpule A: Clinical aspects and management of AIDS-related Kaposi’s sarcoma. Eur J Cancer 2001, 37:1288–1295.PubMedCrossRefGoogle Scholar
  16. 16.
    Pozniak AL, Latif AS, Neill P, et al.: Pulmonary Kaposi’s sarcoma in Africa. Thorax 1992, 47:730–733.PubMedCrossRefGoogle Scholar
  17. 17.
    Duus KM, Lentchitsky V, Wagenaar T, et al.: Wild-type Kaposi’s sarcoma-associated herpesvirus isolated from the oropharynx of immune-competent individuals has tropism for cultured oral epithelial cells. J Virol 2004, 78:4074–4084.PubMedCrossRefGoogle Scholar
  18. 18.
    Pauk J, Huang ML, Brodie SJ, et al.: Mucosal shedding of human herpesvirus 8 in men. N Engl J Med 2000, 343:1369–1377.PubMedCrossRefGoogle Scholar
  19. 19.
    Mbulaiteye SM, Pfeiffer RM, Engels EA, et al.: Detection of Kaposi sarcoma-associated herpesvirus DNA in saliva and buffy-coat samples from children with sickle cell disease in Uganda. J Infect Dis 2004, 190:1382–1386.PubMedCrossRefGoogle Scholar
  20. 20.
    Corey, L, Brodie S, Huang ML, et al.: HHV-8 infection: a model for reactivation and transmission. Rev Med Virol 2002, 12:47–63.PubMedCrossRefGoogle Scholar
  21. 21.
    Johnson AS, Maronian N, Vieira J: Activation of Kaposi’s sarcoma-associated herpesvirus lytic gene expression during epithelial differentiation. J Virol 2005, 79:13769–13777.PubMedCrossRefGoogle Scholar
  22. 22.
    West JT, Wood C: The role of Kaposi’s sarcoma-associated herpesvirus/human herpesvirus-8 regulator of transcription activation (RTA) in control of gene expression. Oncogene 2003, 22:5150–5163.PubMedCrossRefGoogle Scholar
  23. 23.
    Grundhoff A, Ganem D: Inefficient establishment of KSHV latency suggests an additional role for continued lytic replication in Kaposi sarcoma pathogenesis. J Clin Invest 2004, 113:124–136.PubMedCrossRefGoogle Scholar
  24. 24.
    Jung JW, Cho SD, Ahn NS, et al.: Effects of the histone deacetylases inhibitors sodium butyrate and trichostatin A on the inhibition of gap junctional intercellular communication by H2O2-and 12-O-tetradecanoylphorbol-13-acetate in rat liver epithelial cells. Cancer Lett 2006, 241:301–308.PubMedCrossRefGoogle Scholar
  25. 25.
    Morris TL, Arnold RR, Webster-Cyriaque J: Signaling cascades triggered by bacterial metabolic end products during reactivation of Kaposi’s sarcoma-associated herpesvirus. J Virol 2007, 81:6032–6042.PubMedCrossRefGoogle Scholar
  26. 26.
    D’souza G, Kreimer AR, Viscidi R, et al.: Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 2007, 356:1944–1956.PubMedCrossRefGoogle Scholar
  27. 27.
    Kreimer AR, Alberg AJ, Daniel R, et al.: Oral human papillomavirus infection in adults is associated with sexual behavior and HIV serostatus. J Infect Dis 2004, 189:686–698.PubMedCrossRefGoogle Scholar
  28. 28.
    Greenspan D, Canchola AJ, MacPhail LA, et al.: Effect of highly active antiretroviral therapy on frequency of oral warts. Lancet 2001, 357:1411–1412.PubMedCrossRefGoogle Scholar
  29. 29.
    Lilly EA, Cameron JE, Shetty KV, et al.: Lack of evidence for local immune activity in oral hairy leukoplakia and oral wart lesions. Oral Microbiol Immunol 2005, 20:154–162.PubMedCrossRefGoogle Scholar
  30. 30.
    1999 International Workshop for a Classification of Periodontal Diseases and Conditions. Papers. Oak Brook, Illinois, October 30–November 2, 1999. Ann Periodontol 1999, 4:i, 1–112.Google Scholar
  31. 31.
    Paster BJ, Olsen I, Aas JA, Dewhirst FE: The breadth of bacterial diversity in the human periodontal pocket and other oral sites. Periodontol 2000 2006, 42:80–87.PubMedCrossRefGoogle Scholar
  32. 32.
    Haffajee AD, Socransky SS: Microbiology of periodontal diseases: introduction. Periodontol 2000 2005, 38:9–12.PubMedCrossRefGoogle Scholar
  33. 33.
    Holt SC, Ebersole JL: Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia: the “red complex”, a prototype polybacterial pathogenic consortium in periodontitis. Periodontol 2000 2005, 38:72–122.PubMedCrossRefGoogle Scholar
  34. 34.
    Socransky SS, Haffajee AD: Periodontal microbial ecology. Periodontol 2000 2005, 38:135–187.PubMedCrossRefGoogle Scholar
  35. 35.
    Aas JA, Barbuto SM, Alpagot T, et al.: Subgingival plaque microbiota in HIV positive patients. J Clin Periodontol 2007, 34:189–195.PubMedCrossRefGoogle Scholar
  36. 36.
    Slots J: Herpesviruses in periodontal diseases. Periodontol 2000 2005, 38:33–62.PubMedCrossRefGoogle Scholar
  37. 37.
    Slots J: Herpesviral-bacterial synergy in the pathogenesis of human periodontitis. Curr Opin Infect Dis 2007, 20:278–283.PubMedCrossRefGoogle Scholar
  38. 38.
    Corbet EF: Diagnosis of acute periodontal lesions. Periodontol 2000 2004, 34:204–216.PubMedCrossRefGoogle Scholar
  39. 39.
    Jacobson JM, Greenspan JS, Spritzler J, et al.: Thalidomide for the treatment of oral aphthous ulcers in patients with human immunodeficiency virus infection. National Institute of Allergy and Infectious Diseases AIDS Clinical Trials Group. N Engl J Med 1997, 336:1487–1493.PubMedCrossRefGoogle Scholar
  40. 40.
    Shetty K: Thalidomide for recurrent aphthous ulcerations. HIV Clin 2003, 15:1, 4–6.PubMedGoogle Scholar
  41. 41.
    Dalmau J, Alegre M, Domingo P, Alomar A: Major oral aphthous ulceration in HIV-1 infection: successful response after highly active antiretroviral therapy. J Eur Acad Dermatol Venereol 2007, 21:126–127.PubMedCrossRefGoogle Scholar
  42. 42.
    Mitchell J: Meth abuse causes extensive dental decay. Todays FDA 2006, 18:34–35.PubMedGoogle Scholar
  43. 43.
    Shaner JW, Kimmes N, Saini T, Edwards P: “Meth mouth”: rampant caries in methamphetamine abusers. AIDS Patient Care STDS 2006, 20:146–150.PubMedCrossRefGoogle Scholar
  44. 44.
    Ramos-Gomez F: Dental considerations for the paediatric AIDS/HIV patient. Oral Dis 2002, 8(Suppl 2):49–54.PubMedCrossRefGoogle Scholar
  45. 45.
    Naidoo S, Chikte U: Oro-facial manifestations in paediatric HIV: a comparative study of institutionalized and hospital outpatients. Oral Dis 2004, 10:13–18.PubMedCrossRefGoogle Scholar
  46. 46.
    Schiødt M, Greenspan D, Daniels TE, et al.: Parotid gland enlargement and xerostomia associated with labial sialadenitis in HIV-infected patients. J Autoimmun 1989, 2:415–425.PubMedCrossRefGoogle Scholar
  47. 47.
    Pinto A, De Rossi SS: Salivary gland disease in pediatric HIV patients: an update. J Dent Child (Chic) 2004, 71:33–37.Google Scholar
  48. 48.
    Frezzini C, Leao JC, Porter S: Current trends of HIV disease of the mouth. J Oral Pathol Med 2005, 34:513–531.PubMedCrossRefGoogle Scholar
  49. 49.
    Harris NL: Lymphoid proliferations of the salivary glands. Am J Clin Pathol 1999, 111(1 Suppl 1):S94–S103.PubMedGoogle Scholar
  50. 50.
    Coogan MM, Greenspan J, Challacombe SJ: Oral lesions in infection with human immunodeficiency virus. Bull World Health Organ 2005, 83:700–706.PubMedGoogle Scholar
  51. 51.
    Hodgson TA, Naidoo S, Chidzonga M, et al.: (A1) Identification of oral health care needs in children and adults, management of oral diseases. Adv Dent Res 2006, 19:106–117.PubMedGoogle Scholar
  52. 52.
    Chen JW, Flaitz CM, Wullbrandt B, Sexton J: Association of dental health parameters with oral lesion prevalence in human immunodeficiency virus-infected Romanian children. Pediatr Dent 2003, 25:479–484.PubMedGoogle Scholar
  53. 53.
    Ramos-Gomez FJ, Tomar SL, Ellison J, et al.: Assessment of early childhood caries and dietary habits in a population of migrant Hispanic children in Stockton, California. ASDC J Dent Child 1999, 66:395–403.PubMedGoogle Scholar
  54. 54.
    Flaitz C, Wullbrandt B, Sexton J, et al.: Prevalence of orodental findings in HIV-infected Romanian children. Pediatr Dent 2001, 23:44–50.PubMedGoogle Scholar
  55. 55.
    Hauk MJ, Moss ME, Weinberg GA, Berkowitz RJ: Delayed tooth eruption: association with severity of HIV infection. Pediatr Dent 2001, 23:260–262.PubMedGoogle Scholar
  56. 56.
    Futterman DC: HIV in adolescents and young adults: half of all new infections in the United States. Top HIV Med 2005, 13:101–105.PubMedGoogle Scholar
  57. 57.
    Freedman D, Koenig LJ, Wiener J, et al.: Challenges to re-enrolling perinatally HIV-infected and HIV-exposed but uninfected children into a prospective cohort study: strategies for locating and recruiting hard-to-reach families. Paediatr Perinat Epidemiol 2006, 20:338–347.PubMedCrossRefGoogle Scholar
  58. 58.
    Lu FX, Jacobson RS: Oral mucosal immunity and HIV/SIV infection. J Dent Res 2007, 86:216–226.PubMedGoogle Scholar
  59. 59.
    Kazmi SH, Naglik JR, Sweet SP, et al.: Comparison of human immunodeficiency virus type 1-specific inhibitory activities in saliva and other human mucosal fluids. Clin Vaccine Immunol 2006, 13:1111–1118.PubMedCrossRefGoogle Scholar
  60. 60.
    Challacombe SJ, Naglik JR: The effects of HIV infection on oral mucosal immunity. Adv Dent Res 2006, 19:29–35.PubMedCrossRefGoogle Scholar
  61. 61.
    Weinberg A, Quinones-Mateu ME, Lederman MM: Role of human beta-defensins in HIV infection. Adv Dent Res 2006, 19:42–48.PubMedGoogle Scholar
  62. 62.
    Devito C, Hinkula J, Kaul R, et al.: Cross-clade HIV-1-specific neutralizing IgA in mucosal and systemic compartments of HIV-1-exposed, persistently seronegative subjects. J Acquir Immune Defic Syndr 2002, 30:413–420.PubMedGoogle Scholar
  63. 63.
    Chen Z, Mauk MG, Wang J, et al.: A microfluidic system for saliva-based detection of infectious diseases. Ann N Y Acad Sci 2007, 1098:429–436.PubMedCrossRefGoogle Scholar
  64. 64.
    Liu X, Zha J, Chen H, et al.: Human immunodeficiency virus type 1 infection and replication in normal human oral keratinocytes. J Virol 2003, 77:3470–3476.PubMedCrossRefGoogle Scholar
  65. 65.
    Milush JM, Stefano-Cole K, Schmidt K, et al.: Mucosal innate immune response associated with a timely humoral immune response and slower disease progression after oral transmission of simian immunodeficiency virus to rhesus macaques. J Virol 2007, 81:6175–6186.PubMedCrossRefGoogle Scholar
  66. 66.
    Stahl-Hennig C, Steinman RM, Tenner-Racz K, et al.: Rapid infection of oral mucosal-associated lymphoid tissue with simian immunodeficiency virus. Science 1999, 285:1261–1265.PubMedCrossRefGoogle Scholar
  67. 67.
    Abel K, Pahar B, Van Rompay KK, et al.: Rapid virus dissemination in infant macaques after oral simian immunodeficiency virus exposure in the presence of local innate immune responses. J Virol 2006, 80:6357–6367.PubMedCrossRefGoogle Scholar
  68. 68.
    Milush JM, Kosub D, Marthas M, et al.: Rapid dissemination of SIV following oral inoculation. AIDS 2004, 18:2371–2380.PubMedGoogle Scholar
  69. 69.
    Lundholm P, Leandersson AC, Christensson B, et al.: DNA mucosal HIV vaccine in humans. Virus Res 2002, 82:141–145.PubMedCrossRefGoogle Scholar
  70. 70.
    Makitalo B, Lundholm P, Hinkula J, et al.: Enhanced cellular immunity and systemic control of SHIV infection by combined parenteral and mucosal administration of a DNA prime MVA boost vaccine regimen. J Gen Virol 2004, 85:2407–2419.PubMedCrossRefGoogle Scholar
  71. 71.
    Stahl-Hennig C, Kuate S, Franz M, et al.: Atraumatic oral spray immunization with replication-deficient viral vector vaccines. J Virol 2007, [Epub ahead of print.]Google Scholar
  72. 72.
    Hagensee ME, Cameron JE, Leigh JE, Clark RA: Human papillomavirus infection and disease in HIV-infected individuals. Am J Med Sci 2004, 328:57–63.PubMedCrossRefGoogle Scholar
  73. 73.
    Tebas P, Powderly WG, Claxton S, et al.: Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy. AIDS 2000, 14:F63–F67.PubMedCrossRefGoogle Scholar
  74. 74.
    Malizia AP, Cotter E, Chew N, et al.: HIV protease inhibitors selectively induce gene expression alterations associated with reduced calcium deposition in primary human osteoblasts. AIDS Res Hum Retroviruses 2007, 23:243–250.PubMedCrossRefGoogle Scholar
  75. 75.
    Centers for Disease Control and Prevention: HIV/AIDS Surveillance Report. US Department of Health and Human Services 2005, 17:1–54. Scholar
  76. 76.
    CDC: Racial/ethnic disparities in diagnoses of HIV/AIDS-33 states, 2001–2004. MMWR Morb Mortal Wkly Rep 2006, 55:121–125.Google Scholar
  77. 77.
    Navazesh M, Mulligan R, Pogoda J, et al.: The effect of HAART on salivary microbiota in the Women’s Interagency HIV Study (WIHS). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005, 100:701–708.PubMedCrossRefGoogle Scholar
  78. 78.
    Coulter ID, Heslin KC, Marcus M, et al.: Associations of self-reported oral health with physical and mental health in a nationally representative sample of HIV persons receiving medical care. Qual Life Res 2002, 11:57–70.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.AIDS and Immunosuppression ProgramNational Institute of Dental and Craniofacial ResearchBethesdaUSA

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