HIV – A Dental Perspective
Keywords:
medicineAbstract
The treatment of patients infected with HIV (human immunodeficiency virus) is a very
interesting discipline within both medicine and dentistry. Recent advances in antiretroviral
therapies have resulted in infected patients now having much longer symptom-free life spans
and treatment planning now challenges the clinician to be cognisant of all the oral and dental
aspects of the disease and its treatment. As well as influencing the epidemiology of the
classical HIV-related lesions and infections, these drugs are associated with many drug
interactions and adverse side effects. This review aims to describe the significant oral
manifestations of the disease and highlight difficulties in managing this subset of patients.
References
1. Patton LL. HIV disease. Dent Clin North Am
2003;47(3):467-92.
2. Ho DD. Time to hit HIV, early and hard. N Engl J
Med 1995;333(7):450-1.
3. Patton LL, Shugars DC. Immunologic and viral
markers of HIV-1 disease progression: implications for
dentistry. J Am Dent Assoc 1999;130(9):1313-22.
4. Jordan R, Gold L, Cummins C, Hyde C. Systematic
review and meta-analysis of evidence for increasing
numbers of drugs in antiretroviral combination therapy.
BMJ 2002;324(7340):757.
5. Rutherford GW, Sangani PR, Kennedy, GE. Three- or
four- versus two-drug antiretroviral maintenance
regimens for HIV infection (Cochrane Review). The
Cochrane Library 2004(4).
6. National Disease Surveillance Centre. General
information on HIV and AIDS. 2005. Accessed 27
January, 2005 at: http://www.ndsc.ie/DiseaseTopicsAZ/HIVHumanImmunodeficiencyVirus/)
7. Greenspan JS, Barr CE, Sciubba JJ, Winkler JR. Oral
manifestations of HIV infection. Definitions, diagnostic
criteria, and principles of therapy. The U.S.A. Oral
AIDS Collaborative Group. Oral Surg Oral Med Oral
Pathol 1992;73(2):142-4.
8. EC-Clearinghouse on Oral Problems Related to HIV
Infection and WHO Collaborating Centre on Oral
Manifestations of the Immunodeficiency Virus.
Classification and diagnostic criteria for oral lesions in
HIV infection. J Oral Pathol Med 1993;22:289-91.
9. Ramos-Gomez FJ, Flaitz C, Catapano P, Murray PA,
Milnes AR, Dorenbaum A et al. Classification,
diagnostic criteria, and treatment recommendations for
orofacial, manifestations in HIV-infected pediatric
patients. J Clin Paediatr Dent 1999;23(2):85-96.
10. Patton LL, Phelan JA, Ramos-Gomez FJ,
Nittayananta W, Shiboski CH, Mbuguye TL.
Prevalence and classification of HIV-associated oral
lesions. Oral Dis 2002;(8Suppl2):98-109.
11. Tappuni AR, Fleming GJ. The effect of
antiretroviral therapy on the prevalence of oral
manifestations in HIV-infected patients: a UK study.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2001;92(6):623-8.
12. Eyeson JD, Warnakulasuriya KA, Johnson NW.
Prevalence and incidence of oral lesions--the changing
scene. Oral Dis 2000;6(5):267-73.
13. Schmidt-Westhausen AM, Priepke F, Bergmann FJ,
Reichart PA. Decline in the rate of oral opportunistic
infections following introduction of highly active
antiretroviral therapy. J Oral Pathol Med
2000;29(7):336-41.
14. Eyeson JD, Tenant-Flowers M, Cooper DJ, Johnson
NW, Warnakulasuriya KA. Oral manifestations of an
HIV positive cohort in the era of highly active antiretroviral therapy (HAART) in South London. J Oral
Pathol Med 2002;31(3):169-74.
15. Margiotta V, Campisi G, Mancuso S, Accurso V,
Abbadessa V. HIV infection: oral lesions, CD4+ cell
count and viral load in an Italian study population. Oral
Pathol Med 1999;28(4):173-7.
16. Patton LL, McKaig R, Strauss R, Rogers D, Eron JJ
Jr. Changing prevalence of oral manifestations of
human immuno-deficiency virus in the era of protease
inhibitor therapy. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2000;89(3):299-304.
17. Ferguson FS, Nachman S, Berentsen B.
Implications and management of oral diseases in
children and adolescents with HIV infection. N Y State
Dent J 1997;63(2):46-50.
18. Nittayananta W, Chungpanich S. Oral lesions in a
group of Thai people with AIDS. Oral Dis
1997;(3Suppl1):S41-5.
19. Reichart PA. Oral manifestations in HIV infection:
fungal and bacterial infections, Kaposi's sarcoma. Med
Microbiol Immunol (Berl) 2003;192(3):165-9.
20. De Bernardis F, Tacconelli E, Mondello F, et al.
Anti-retroviral therapy with protease inhibitors
decreases virulence enzyme expression in vivo by
Candida albicans without selection of avirulent fungus
strains or decreasing their anti-mycotic susceptibility.
FEMS Immunol Med Microbiol 2004;41(1):27-34.
21. Ceballos-Salobrena A, Gaitain-Cepeda L, CeballosGarcia L, Samaranayake LP. The effect of antiretroviral
therapy on the prevalence of HIV-associated oral
candidiasis in a Spanish cohort. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2004;97(3):345-50.
22. Holmes H, Peinaar ED. Interventions for the
prevention and management of oropharyngeal
candidiasis associated with HIV infection in adults and
children (Protocol for Cochrane Review). The
Cochrane Library, 2004(3).
23. Powderly WG, Gallant JE, Ghannoum MA, Mayer
KH, Navarro EE, Perfect JR. Oropharyngeal
candidiasis in patients with HIV: suggested guidelines
for therapy. AIDS Res Hum Retroviruses
1999;15(18):1619-23.
24. Flint SR, O'Sullivan C, Arthur N. An update of
adverse drug reactions of relevance to general dental
practice. J Ir Dent Assoc 2000;46(2):67-70.
25. Lewis DA. Antiretroviral combination therapy for
HIV infection. Dent Update 2003;30:242-47.
26. Monthly Index of Medical Specialties Ireland.
p.182, December 2004.
27. British National Formulary. British Medical
Association, Royal Pharmaceutical Society of Great
Britain editors. Appendix 1; p.629-65. September
2004;48.
28. Madigan A, Murray PA, Houpt M, Catalanotto F,
Feuerman M. Caries experience and cariogenic markers
in HIV-positive children and their siblings. Pediatr
Dent 1996;18(2):129-36.
29. Phelan JA, Mulligan R, Nelson E, Brunelle J, Alves
MEAF, Navazesh M, Greenspan D. Dental Caries in
HIV-seropositive Women. J Dent Res 2004;83(11):869-
873.
30. Johnson GK, Hill M. Cigarette smoking and the
periodontal patient. J Periodontol 2004;75(2):196-209.
31. Anonymous. Position paper: tobacco use and the
periodontal patient. Research, Science and Therapy
Committee of the American Academy of
Periodontology. J Periodontol 1999;70(11):1419-27.
32. U.S. Department of Health and Human Services.
Antiretroviral Postexposure Prophylaxis After Sexual,
Injection-Drug Use, or Other Nonoccupational
Exposure to HIV in the United States (2005). (Accessed
25 December, 2005 at: http://www.aidsinfo.nih.gov/)
33. Diz Dios P, Ocampo Hermida A, Miralles Alvarez
C, Vazquez Garcia E, Martinez Vazquez C. Regression
of AIDS-related Kaposi's sarcoma following ritonavir
therapy. Oral Oncol 1998;34(3):236-8.
34. Greenspan D, Canchola AJ, MacPhail LA, Cheikh
B, Greenspan JS. Effect of highly active antiretroviral
therapy on frequency of oral warts. Lancet
2001;357(9266):1411-2.
35. King MD, Reznik DA, O'Daniels CM, Larsen NM,
Osterholt D, Blumberg HM. Human papillomavirusassociated oral warts among human immunodeficiency
virus-seropositive patients in the era of highly active
antiretroviral therapy: an emerging infection. Clin
Infect Dis 2002;34(5):641-8.
36. Scully C, Cawson RA. Viral infections. In: Scully
C, Cawson RA, eds. Medical problems in dentistry. 5th
ed. London: Elsevier, 2005:398-408.
37. Allan JD, Connolly KJ, Fitch H, et al. Long-term
follow-up of didanosine administered orally twice daily
to patients with advanced human immunodeficiency
virus infection and hematologic intolerance of
zidovudine. Clin Infect Dis 1993;16(Suppl1):S46-51.
38. Scully C, Diz Dios P. Orofacial effects of
antiretroviral therapies. Oral Dis 2001;7(4):205-10.
39. Greenwood I, Heylen R, Zakrzewska JM. Antiretroviral drugs – implications for dental prescribing. Br
Dent J 1998;184(10):478-82.
40. Porter SR, Scully C. HIV topic update: protease
inhibitor therapy and oral health care. Oral Dis
1998;4(3):159-63.
41. Rule J, Veatch R. Ethical Questions in Dentistry.
Chicago: Quintessence Publishing Co. Ltd:151-62.
42. Doyal L. Good ethical practice in the dental
treatment of patients with HIV/AIDS. Oral Dis
1997;3(Suppl1):S214-20.
43. Greene VA, Chu SY, Diaz T, Schable B. Oral health
problems and use of dental services among HIVinfected adults. Supplement to HIV/AIDS Surveillance
Project Group. J Am Dent Assoc 1997;128(10):1417-22.
44. Shirlaw PJ, Chikte U, MacPhail L, SchmidtWesthausen A, Croser D, Reichart P. Oral and dental
care and treatment protocols for the management of
HIV-infected patients. Oral Dis 2002;8(Suppl 2):136-
43.
45. Flint SR, Power J, Lawlor E. Hepatitis C and the
dental practitioner. J Ir Dent Assoc 1994;40(2):37-8.
46. Barbaro G, Di Lorenzo G, Grisorio B, Barbarini G.
Cardiac involvement in the acquired immunodeficiency
syndrome: a multicenter clinical-pathological study.
Gruppo Italiano per lo Studio Cardiologico dei pazienti
affetti da AIDS Investigators. AIDS Res Hum
Retroviruses 1998;14(12):1071-7.
47. Ruiz L, van Lunzen J, Arno A, et al. Protease
inhibitor-containing regimens compared with
nucleoside analogues alone in the suppression of
persistent HIV-1 replication in lymphoid tissue. AIDS
1999;13(1):F1-8.
2003;47(3):467-92.
2. Ho DD. Time to hit HIV, early and hard. N Engl J
Med 1995;333(7):450-1.
3. Patton LL, Shugars DC. Immunologic and viral
markers of HIV-1 disease progression: implications for
dentistry. J Am Dent Assoc 1999;130(9):1313-22.
4. Jordan R, Gold L, Cummins C, Hyde C. Systematic
review and meta-analysis of evidence for increasing
numbers of drugs in antiretroviral combination therapy.
BMJ 2002;324(7340):757.
5. Rutherford GW, Sangani PR, Kennedy, GE. Three- or
four- versus two-drug antiretroviral maintenance
regimens for HIV infection (Cochrane Review). The
Cochrane Library 2004(4).
6. National Disease Surveillance Centre. General
information on HIV and AIDS. 2005. Accessed 27
January, 2005 at: http://www.ndsc.ie/DiseaseTopicsAZ/HIVHumanImmunodeficiencyVirus/)
7. Greenspan JS, Barr CE, Sciubba JJ, Winkler JR. Oral
manifestations of HIV infection. Definitions, diagnostic
criteria, and principles of therapy. The U.S.A. Oral
AIDS Collaborative Group. Oral Surg Oral Med Oral
Pathol 1992;73(2):142-4.
8. EC-Clearinghouse on Oral Problems Related to HIV
Infection and WHO Collaborating Centre on Oral
Manifestations of the Immunodeficiency Virus.
Classification and diagnostic criteria for oral lesions in
HIV infection. J Oral Pathol Med 1993;22:289-91.
9. Ramos-Gomez FJ, Flaitz C, Catapano P, Murray PA,
Milnes AR, Dorenbaum A et al. Classification,
diagnostic criteria, and treatment recommendations for
orofacial, manifestations in HIV-infected pediatric
patients. J Clin Paediatr Dent 1999;23(2):85-96.
10. Patton LL, Phelan JA, Ramos-Gomez FJ,
Nittayananta W, Shiboski CH, Mbuguye TL.
Prevalence and classification of HIV-associated oral
lesions. Oral Dis 2002;(8Suppl2):98-109.
11. Tappuni AR, Fleming GJ. The effect of
antiretroviral therapy on the prevalence of oral
manifestations in HIV-infected patients: a UK study.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2001;92(6):623-8.
12. Eyeson JD, Warnakulasuriya KA, Johnson NW.
Prevalence and incidence of oral lesions--the changing
scene. Oral Dis 2000;6(5):267-73.
13. Schmidt-Westhausen AM, Priepke F, Bergmann FJ,
Reichart PA. Decline in the rate of oral opportunistic
infections following introduction of highly active
antiretroviral therapy. J Oral Pathol Med
2000;29(7):336-41.
14. Eyeson JD, Tenant-Flowers M, Cooper DJ, Johnson
NW, Warnakulasuriya KA. Oral manifestations of an
HIV positive cohort in the era of highly active antiretroviral therapy (HAART) in South London. J Oral
Pathol Med 2002;31(3):169-74.
15. Margiotta V, Campisi G, Mancuso S, Accurso V,
Abbadessa V. HIV infection: oral lesions, CD4+ cell
count and viral load in an Italian study population. Oral
Pathol Med 1999;28(4):173-7.
16. Patton LL, McKaig R, Strauss R, Rogers D, Eron JJ
Jr. Changing prevalence of oral manifestations of
human immuno-deficiency virus in the era of protease
inhibitor therapy. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2000;89(3):299-304.
17. Ferguson FS, Nachman S, Berentsen B.
Implications and management of oral diseases in
children and adolescents with HIV infection. N Y State
Dent J 1997;63(2):46-50.
18. Nittayananta W, Chungpanich S. Oral lesions in a
group of Thai people with AIDS. Oral Dis
1997;(3Suppl1):S41-5.
19. Reichart PA. Oral manifestations in HIV infection:
fungal and bacterial infections, Kaposi's sarcoma. Med
Microbiol Immunol (Berl) 2003;192(3):165-9.
20. De Bernardis F, Tacconelli E, Mondello F, et al.
Anti-retroviral therapy with protease inhibitors
decreases virulence enzyme expression in vivo by
Candida albicans without selection of avirulent fungus
strains or decreasing their anti-mycotic susceptibility.
FEMS Immunol Med Microbiol 2004;41(1):27-34.
21. Ceballos-Salobrena A, Gaitain-Cepeda L, CeballosGarcia L, Samaranayake LP. The effect of antiretroviral
therapy on the prevalence of HIV-associated oral
candidiasis in a Spanish cohort. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2004;97(3):345-50.
22. Holmes H, Peinaar ED. Interventions for the
prevention and management of oropharyngeal
candidiasis associated with HIV infection in adults and
children (Protocol for Cochrane Review). The
Cochrane Library, 2004(3).
23. Powderly WG, Gallant JE, Ghannoum MA, Mayer
KH, Navarro EE, Perfect JR. Oropharyngeal
candidiasis in patients with HIV: suggested guidelines
for therapy. AIDS Res Hum Retroviruses
1999;15(18):1619-23.
24. Flint SR, O'Sullivan C, Arthur N. An update of
adverse drug reactions of relevance to general dental
practice. J Ir Dent Assoc 2000;46(2):67-70.
25. Lewis DA. Antiretroviral combination therapy for
HIV infection. Dent Update 2003;30:242-47.
26. Monthly Index of Medical Specialties Ireland.
p.182, December 2004.
27. British National Formulary. British Medical
Association, Royal Pharmaceutical Society of Great
Britain editors. Appendix 1; p.629-65. September
2004;48.
28. Madigan A, Murray PA, Houpt M, Catalanotto F,
Feuerman M. Caries experience and cariogenic markers
in HIV-positive children and their siblings. Pediatr
Dent 1996;18(2):129-36.
29. Phelan JA, Mulligan R, Nelson E, Brunelle J, Alves
MEAF, Navazesh M, Greenspan D. Dental Caries in
HIV-seropositive Women. J Dent Res 2004;83(11):869-
873.
30. Johnson GK, Hill M. Cigarette smoking and the
periodontal patient. J Periodontol 2004;75(2):196-209.
31. Anonymous. Position paper: tobacco use and the
periodontal patient. Research, Science and Therapy
Committee of the American Academy of
Periodontology. J Periodontol 1999;70(11):1419-27.
32. U.S. Department of Health and Human Services.
Antiretroviral Postexposure Prophylaxis After Sexual,
Injection-Drug Use, or Other Nonoccupational
Exposure to HIV in the United States (2005). (Accessed
25 December, 2005 at: http://www.aidsinfo.nih.gov/)
33. Diz Dios P, Ocampo Hermida A, Miralles Alvarez
C, Vazquez Garcia E, Martinez Vazquez C. Regression
of AIDS-related Kaposi's sarcoma following ritonavir
therapy. Oral Oncol 1998;34(3):236-8.
34. Greenspan D, Canchola AJ, MacPhail LA, Cheikh
B, Greenspan JS. Effect of highly active antiretroviral
therapy on frequency of oral warts. Lancet
2001;357(9266):1411-2.
35. King MD, Reznik DA, O'Daniels CM, Larsen NM,
Osterholt D, Blumberg HM. Human papillomavirusassociated oral warts among human immunodeficiency
virus-seropositive patients in the era of highly active
antiretroviral therapy: an emerging infection. Clin
Infect Dis 2002;34(5):641-8.
36. Scully C, Cawson RA. Viral infections. In: Scully
C, Cawson RA, eds. Medical problems in dentistry. 5th
ed. London: Elsevier, 2005:398-408.
37. Allan JD, Connolly KJ, Fitch H, et al. Long-term
follow-up of didanosine administered orally twice daily
to patients with advanced human immunodeficiency
virus infection and hematologic intolerance of
zidovudine. Clin Infect Dis 1993;16(Suppl1):S46-51.
38. Scully C, Diz Dios P. Orofacial effects of
antiretroviral therapies. Oral Dis 2001;7(4):205-10.
39. Greenwood I, Heylen R, Zakrzewska JM. Antiretroviral drugs – implications for dental prescribing. Br
Dent J 1998;184(10):478-82.
40. Porter SR, Scully C. HIV topic update: protease
inhibitor therapy and oral health care. Oral Dis
1998;4(3):159-63.
41. Rule J, Veatch R. Ethical Questions in Dentistry.
Chicago: Quintessence Publishing Co. Ltd:151-62.
42. Doyal L. Good ethical practice in the dental
treatment of patients with HIV/AIDS. Oral Dis
1997;3(Suppl1):S214-20.
43. Greene VA, Chu SY, Diaz T, Schable B. Oral health
problems and use of dental services among HIVinfected adults. Supplement to HIV/AIDS Surveillance
Project Group. J Am Dent Assoc 1997;128(10):1417-22.
44. Shirlaw PJ, Chikte U, MacPhail L, SchmidtWesthausen A, Croser D, Reichart P. Oral and dental
care and treatment protocols for the management of
HIV-infected patients. Oral Dis 2002;8(Suppl 2):136-
43.
45. Flint SR, Power J, Lawlor E. Hepatitis C and the
dental practitioner. J Ir Dent Assoc 1994;40(2):37-8.
46. Barbaro G, Di Lorenzo G, Grisorio B, Barbarini G.
Cardiac involvement in the acquired immunodeficiency
syndrome: a multicenter clinical-pathological study.
Gruppo Italiano per lo Studio Cardiologico dei pazienti
affetti da AIDS Investigators. AIDS Res Hum
Retroviruses 1998;14(12):1071-7.
47. Ruiz L, van Lunzen J, Arno A, et al. Protease
inhibitor-containing regimens compared with
nucleoside analogues alone in the suppression of
persistent HIV-1 replication in lymphoid tissue. AIDS
1999;13(1):F1-8.
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Published
2005-01-01
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O’Halloran, M. . (2005). HIV – A Dental Perspective. Trinity Student Medical Journal , 6(1). Retrieved from https://ojs.tchpc.tcd.ie/index.php/tsmj/article/view/1951
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