HIV: Infection Control/Exposure Control Issues for Oral Healthcare Personnel
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

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