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Oral Manifestations of HIV Infection

Mary Weinert, MD, MPH; Richard M. Grimes, PhD; and Denis P. Lynch, DDS, PhD
[+] Article, Author, and Disclosure Information

From the University of Texas at Houston Health Science Center and Baylor College of Medicine, Houston, Texas; and the College of Dentistry and College of Medicine at the University of Tennessee, Memphis, Tennessee. Grant Support: In part by the Division of Medicine, Bureau of Health Professions, Health Resources and Services Administration, U.S. Public Health Service, under cooperative agreement 5D35PE00116-04. Requests for Reprints: Richard M. Grimes, PhD, University of Texas, School of Public Health, RAS 345, PO Box 20186, Houston, TX 77225-0186. Current Author Addresses: Dr. Weinert: Baylor College of Medicine, 6560 Fannin, Suite 1540, Houston, TX 77030.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(6):485-496. doi:10.7326/0003-4819-125-6-199609150-00010
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Objective: To provide a comprehensive, literature-based guide to the diagnosis of and the management and referral of patients with oral diseases associated with human immunodeficiency virus (HIV) infection.

Data Sources: The literature was reviewed to identify common oral manifestations of HIV infection, the physical and laboratory findings associated with them, and the therapies used to treat them. The National Library of Medicine's AIDSLINE database was searched using the term “mouth diseases.” Additional references were identified from the bibliographies of these articles and related textbooks.

Study Selection: English-language abstracts were reviewed to determine each paper's clinical relevance. To be considered clinically relevant, a paper had to describe the physical appearance of oral manifestations, methods used to diagnose oral manifestations, or treatment and referral guidelines. More than 600 abstracts were identified.

Data Extraction: After the abstracts were reviewed, articles were selected and were reviewed for possible inclusion. If both of two reviewers agreed that an article was clinically relevant and dealt with conditions that occurred in more than 1% of HIV-infected patients, the article was included.

Data Synthesis: 16 conditions that occur in more than 1% of HIV-infected patients were identified. Information on these conditions was collected and sorted into three categories: clinical appearance, diagnostic methods, and treatment.

Conclusions: Almost all patients with HIV infection will contract oral diseases. Guidelines for recognizing, diagnosing, and managing these conditions are presented. Most conditions can be treated or alleviated through the combined efforts of the physician and the dentist.


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Figure 1. Angular cheilitis. Pseudomembranous candidiasis. Hyperplastic candidiasis. Hairy leukoplakia.
White or yellowish white lesions associated with human immunodeficiency virus infection.Top.Upper middle.Lower middle.Bottom.
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Figure 2. Erythematous candidiasis. Kaposi sarcoma. Non-Hodgkin lymphoma.
Red or reddish purple lesions associated with human immunodeficiency virus infection.Top.Upper and Lower middle.Bottom.
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Grahic Jump Location
Figure 3. Herpes simplex virus ulcer. Varicellazoster virus ulcer. Cytomegalovirus ulcer. Aphthous ulcer.
Oral ulcers associated with human immunodeficiency virus infection.Top.Upper middle.Lower middle.Bottom.
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Figure 4. Linear gingivitis. Necrotizing gingivitis. Necrotizing periodontitis. Necrotizing stomatitis.
Structures with abnormal appearance associated with human immunodeficiency virus infection.Top.Upper middle.Lower middle.Bottom.
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