The Tribune

By Dr Tamika Ferguson

HIV (human immunodeficiency virus) is a virus that attacks the immune system, which is our body's defence against illness. The virus is passed from one person to the next through blood-to-blood contact and sexual contact. It can also be passed from an infected pregnant woman (especially not on antiretroviral medication) to her child during pregnancy, delivery or if the mother breast feeds the child.

HIV attacks a type of white blood cell in the immune system called CD4 cells. As HIV destroys more CD4 cells, it makes it harder for an individual to fight off infections, breaking down a person's immune system. Therefore, for the individual living with HIV, who is not receiving treatment, a simple cold can be severe because your body has difficulty healing.

AIDS (acquired immunodeficiency syndrome) is the most advanced stage of the HIV infection. AIDS is diagnosed when the CD4 cell count drops below 200. The normal range for CD4 cells is about 500-1,500.

HIV leaves you vulnerable to a wide variety of diseases. Oral diseases are especially common in individuals with HIV; more than a third of those who are HIV-positive suffer from oral health problems. The detection of oral diseases can be critical because it may suggest possible HIV infection in an unaware individual. The discovery of oral manifestations in an individual with HIV but not on an active therapy may signal progression of HIV disease. Further, if new oral conditions occur in a patient receiving antiretroviral therapy, it may lead to reevaluation of their therapeutic regimen.

Here are some oral diseases associated with HIV:

• Oral warts

These oral warts are caused by the human papillomavirus (HPV), and are more prevalent in HIV-infected patients than non-infected individuals.

The treatment of choice for warts is surgical removal but even after removal they may still recur.

• Oral hairy leukoplakia

Hairy leukoplakia results in white patches that do not rub off on the side of your tongue. It can be painful and may affect the way your food tastes. Hairy leukoplakia is the most common Epstein-Barr Virus (EBV) related lesion in patients with HIV. EBV usually affects persons with a weak immune system, the detection of hairy leukoplakia may be the first sign an individual is HIV-positive and requires treatment.

• Oral thrush

Oral thrush (oral candidiasis) produces white sores on your tongue and the inside of your mouth. Thrush and hairy leukoplakia look similar, but oral thrush can be wiped away. Oral candidiasis can be painful and associated with reduced taste and smell.

It is caused by a fungus called Candida albicans which is present in small amounts in a healthy individual's mouth. In HIV-infected persons, the amount of candida can grow beyond one's control. Oral thrush can be treated with anti-fungal medications.

• HIV-associated periodontal disease

People who are HIV-positive are more susceptible to developing gum disease than individual's with a healthy immune system. There are three patterns of periodontal disease strongly associated with HIV infection: linear gingival erythema, necrotizing ulcerative gingivitis and necrotizing ulcerative periodontitis.

The treatment for HIV-associated periodontal disease revolves around debridement, antimicrobial therapy, immediate follow-up care and long-term maintenance. The patient must also have good oral hygiene practices.

Conclusion

HIV weakens your immune system which affects your entire body, including your mouth. Oral manifestations of HIV disease are very common. It is important to be aware of any changes inside your mouth, and see your dentist right away if you notice any major concerns.