HIV: Infection Control/Exposure Control Issues for Oral Healthcare Personnel
Course Number: 97
Course Contents
Clinical Manifestations
Available scientific evidence suggests a dynamic process in which initial and ongoing immunological responses to HIV infection are not only unsuccessful in clearing HIV but, paradoxically, they are paralleled by a progressive reduction in immunocompetence.7 Individual variations exist, but a pattern of disease progression has been established as consisting of three phases: (1) primary infection, (2) a period of clinical latency, and, finally, (3) clinically apparent disease.7
After an incubation period of 1 to 3 weeks, 50% to 80% of patients experience an ill-defined Acute Retroviral Syndrome characterized by fever, lethargy, malaise, sore throat, arthralgia, myalgia, headaches, photophobia, maculopapular rash, and lymphadenopathy.7,8 Antibodies can be detected 3 to 6 months after exposure. During clinical latency (8 to 24 months), the patient is free of overt signs and symptoms. Clinically apparent disease is characterized by opportunistic illnesses (Table 1).9
Table 1. Opportunistic illnesses (AIDS-defining conditions).9
- Bacterial infections, multiple or recurrent*
- Candidiasis of bronchi, trachea, or lungs
- Candidiasis, esophageal
- Cervical cancer, invasive†
- Coccidioidomycosis, disseminated or extrapulmonary
- Cryptococcosis, extrapulmonary
- Cryptosporidiosis, chronic intestinal (> one month’s duration)
- Cytomegalovirus disease (other than liver, spleen, or nodes), onset at age > 1 month
- Cytomegalovirus retinitis (with loss of vision)
- Encephalopathy attributed to HIV§
- Herpes simplex: chronic ulcer(s) (> month’s duration); or bronchitis, pneumonitis, or esophagitis (onset at age >1 month)
- Histoplasmosis, disseminated or extrapulmonary
- Isosporiasis, chronic intestinal (greater than one month’s duration)
- Kaposi sarcoma
- Lymphoma, Burkitt’s (or equivalent term)
- Lymphoma, immunoblastic (or equivalent term)
- Lymphoma, primary, of brain
- Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary
- Mycobacterium tuberculosis of any site, pulmonary† or extrapulmonary
- Mycobacterium, other species or unidentified species, disseminated or extrapulmonary
- Pneumocystis jirovecii (previously known as Pneumocystis carinii) pneumonia
- Pneumonia, recurrent†
- Progressive multifocal leukoencephalopathy
- Salmonella septicemia, recurrent
- Toxoplasmosis of brain, onset at age > 1 month
- Wasting syndrome attributed to HIV§
- *Only among children aged <6 years
- † Only among adults, adolescents, and children aged ≥6 years
- § Suggested diagnostic criteria for these illnesses, which might be particularly important for HIV encephalopathy and HIV wasting syndrome, are described in the following references:
- CDC. 1994 Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR 1994;43(No. RR-12). CDC. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992;41(No. RR-17).
There are also many HIV-associated oral lesions (Table 2), the most notable ones being candidiasis (erythematous, pseudomembranous), hairy leukoplakia, Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and periodontal disease (linear gingival erythema, necrotizing ulcerative periodontitis).10-23 HIV-associated oral lesions are useful markers of HIV disease and hairy leukoplakia and oral candidiasis are positive predictors of HIV disease progression.10-23
Kaposi's Sarcoma
Hairy Leukoplakia
Oral Candidiasis
| Group 1 Lesions strongly associated with HIV infection | Candidiasis Erythematous Pseudomembraneous Hairy leukoplakia Kaposi’s sarcoma Non-Hodgkin’s lymphoma Periodontal disease Linear gingival erythema Necrotizing (ulcerative) gingivitis Necrotizing (ulcerative) periodontitis |
| Group 2 Lesions less commonly associated with HIV infection | Bacterial infections Mycobacterium avium-intracellularae Mycobacterium tuberculosis Melanotic hyperpigmentation Necrotizing (ulcerative) stomatitis Salivary gland disease Dry mouth due to decreased salivary flow rate Swelling of major salivary glands Thrombocytopenia purpura Ulceration NOS (not otherwise specified) Viral infections Herpes simplex virus Human papillomavirus (warty-like) lesions Condyloma acuminatum Focal epithelial hyperplasia Verruca vulgaris Varicella-zoster virus Herpes zoster Varicella |
| Group 3 Lesions seen in HIV infection | Bacterial Actinomyces israelii Escherichia coli Klebsiella pneumonia Cat-scratch disease Drug reactions (ulcerative, erythema multiforme, lichenoid, toxic epidermolysis) Epithelioid (bacillary) angiomatosis Fungal infection other than candidiasis Cryptococcus neoformans Geotrichum candidum Histoplasma capsulatum Mucoraceae (mucormycosis zygomycosis) Aspergillus flavus Neurological disturbances Facial palsy Trigeminal neuralgia Recurrent aphthous stomatitis Viral infections Cytomegalovirus Molluscum contagiosum |