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
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 |