Oral manifestations of HIV-infected patients : With special references to oral hairy leukoplakia and intraoral Kaposi's sarcoma

Oral manifestations in HIV infection are numerous and some of these have been acknowledged as being of great importance in the early diagnosis of the disease. Oral manifestations in HIV-infected individuals occurred as mycotic, bacterial or viral infection, neoplasms or manifestations of unknown etiology. Oral candidiasis occurring as pseudomembranous, hyperplastic and erythematous types should be considered. Oral hairy leukoplakia is characterized by whitish plaques at the lateral border of the tongue which cannot be rubbed off. Light microscopic investigations indicated that the lesion is characterized by parakeratosis, acanthosis, koilocytosis and lack of inflammation in the subepithelial tissue. Using electron microscopy, particles of the herpes virus group (Epstein-Barr virus) were found in the upper two thirds of the epithelium in this lesion. Oral hairy leukoplakia is an early sign of HIV infection and its importance relates to the development of AIDS (mostly Pneumocystis carinii pneumonia) in 83% of the affected patients within 31 months after its diagnosis. The oral cavity may be the only or initial site of Kaposi's sarcoma, and therefore, becomes important in the diagnosis. Histologically, Kaposi's sarcoma consists of two principal components : endothelium-lined vessels in early, macular lesions and spindle cells in late, nodular lesions. HIV gingivitis and periodontitis are of particular significance. Early and correct diagnosis of HIV-associated manifestations are important to the patients as well as the dentists who should install adequate protection measures