Running Head: SYMPTOMS OF AIDS AS SEEN BY DENTAL PROFESSIONALS 1

Symptom of Aids as Seen by Dental Professionals;

Emphasis Applied on Candidiasis and Kaposi Sarcoma

Mary Grace Sears

Seattle Central College

05/18/2017
SYMPTOMS OF AIDS AS SEEN BY DENTAL PROFESSIONALS 2

Table of Contents
INTRODUCTION....................................................................................................................................... 3
OVERVIEW .............................................................................................................................................. 3
CANDIDIASIS ........................................................................................................................................... 4
KAPOSI SARCOMA ................................................................................................................................... 5
CONCLUSION .......................................................................................................................................... 7
SYMPTOMS OF AIDS AS SEEN BY DENTAL PROFESSIONALS 3

INTRODUCTION

This research paper will review Symptoms of Aids as Seen by Dental Professionals, with

emphasis on the opportunistic infections Candidiasis, as well as Kaposi Sarcoma. People who

have contracted HIV can go many years unaware of the infection that they have acquired, this is

the period known as the Asymptomatic stage. In this stage, there are no apparent signs of

sickness, all the while the virus is replicating in the body and destroying the immune system.

Overtime the immune system becomes suppressed and the body’s defense mechanisms will

become compromised. It is during this latent stage where opportunistic infections in the body

such as Candidiasis and Kaposi Sarcoma will begin to manifest and display physical symptoms.

(Moore Syphard,& Heal 2014)

OVERVIEW

In many developing countries, the laboratory markers CD4+ lymphocyte count and HIV

viral load used in monitoring HIV disease progression, are not readily available. To counter this

issue, clinical findings discovered during oral screening processes are used as an alternative. Oral

findings play a critical role in the detection of infection, prognosis of viral infection development

and progression to AIDS. (Pakfetrat et al., 2015) According to Pakfetrat et al. (2015), “Oral

lesions are the earliest and most important indicators of AIDS disease progression and may

develop in up to 50% of HIV-infected patients and in up to 80% of AIDS patients” (pg. 19).

Factors that contribute to predisposition of oral lesions incurred by HIV infection include CD4

counts less than 200 cells/mm3, viral load greater than 3000 copies/mL, xerostomia, poor oral

hygiene, and smoking (Shetti, Gupta, & Charantimath, 2011).

SYMPTOMS OF AIDS AS SEEN BY DENTAL PROFESSIONALS 4

In referencing Bajpai & Pazare (2010), “There are numerous oral manifestations that an

HIV infected patient may experience, they can be categorized into

• Infections: bacterial, fungal, viral

• Neoplasms: Kaposi's sarcoma, non-Hodgkin's lymphoma

• Immune mediated: major aphthous, necrotizing stomatitis

• Others: parotid diseases, nutritional, xerostomia

• Oral manifestations as adverse effects of antiretroviral therapy.” (pg.5 )

Aids diagnosis can only be established by a healthcare provider based on a confirmed HIV test

result, the presence of certain defining physical conditions, and the CD-4 cell count of less than

200 cells/mm3. Included in the defining physical conditions are AIDS defining diseases such as

Esophogial Candidiasis and Karposi Sarcoma. (Moore Syphard,& Heal 2014

CANDIDIASIS

Candida Albicans is a fungal organism of yeast origin that is typically present in the oral

cavity in a nonpathogenic state. It is generally presented in healthy individuals but under

favorable conditions, Candida Albicans has the ability to colonize in increased numbers and

transform into its pathogenic form of Candidiasis (Shetti, Gupta, & Charantimath, 2011).

Symptomatic mucosal candidiasis arises in subjects colonized with Candida who are predisposed

by illness, debility, or a local reduction in host resistance, such as seen with the suppressed

immune system of an HIV infected patient (Vazquez, 2010). Oral Candidiasis is the most

prevalent HIV-related oral disorder occurring in 17-43% of infected persons and over 90% of

AIDS patients will develop Oropharyngeal Candidiasis during their ailment.

SYMPTOMS OF AIDS AS SEEN BY DENTAL PROFESSIONALS 5

Candida Albicans can present in four different forms including Pseudomembranous Candidiasis,

Hyperplastic Candidiasis, Erythematous Candidiasis, and Angular Cheilitis. Erythematous

candidiasis is distinguished as a red, flat, understated lesion either on the dorsal surface of the

tongue and/or the hard/soft palates. Physical symptoms that patients commonly experience are a

burning sensation in the mouth after eating spicy or salty foods (Shetti et al.,2011).

Pseudomembranous Candidiasis presents creamy white curd-like plaques on the inside of the

cheeks, tongue, and other oral tissue surfaces that can be wiped away, leaving a red or bleeding

surface. Angular cheilitis is viewed as fissuring and cracks of the corners of the mouth.

Hyperplastic or chronic candidiasis presents as white non-removable plaques over the mucosal

surface, these affected areas cannot be scraped off (Bajpai & Pazare 2010).

Pseudomembranous Candidiasis, also known as Thrush, is the most common fungal

infection of HIV disease, ranging from 55.8 to 69.7%, of persons infected and it is generally

succeeded by Erythmatous Candidiasis at 25.7–50% (Leao, Ribeiro,Carvalho,Frezzini, & Porter,

2009). Thrush coupled with the presence of Esophageal Candida, may be the first oral

manifestation of AIDS experienced by the patient. Candida Esophagitis will usually cause

dysphagia, odynohagia, and retrosternal pain. The treatments administered for Candidiasis are

usually anti-fungal agents, but is difficult to completely rid the immunocompromised patient of

Candidiasis (Vazquez, 2010).

KAPOSI SARCOMA

Another Aids defining Illness that can be viewed by dental professionals is Kaposi

Sarcoma, which was first chronicled by dermatologist Moritz Kaposi in the year 1872. This

disease is a malignant cancer type that is regularly associated with HIV infected persons and was

one of the very first diseases that contributed to defining AIDS in 1981 (Shetty, K. 2005).
SYMPTOMS OF AIDS AS SEEN BY DENTAL PROFESSIONALS 6

Kaposi Sarcoma is caused by infection with a virus called the Kaposi sarcoma associated

herpesvirus (KSHV), also known as human herpes virus 8 (HHV8). The cells that line lymph and

blood vessels become infected with the KSHV virus. The virus then subsequently introduces

genes into the cells that cause rapid division and precipitate longer cell life, turning them into

cancer cells.

There are several different forms of Kaposi Sarcoma, but the most prominent and

aggressive form is Epidemic Kaposi Sarcoma (aids related) (American Cancer Society. Kaposi

Sarcoma 2016). This form of Kaposi Sarcoma occurs frequently in all HIV transmission groups,

but it has a predominance among homosexual men. Evidence shows that Kaposi Sarcoma is

caused by Human Herpes virus 8 (HHV-8). Oral Lesions may be the initial site to express

Kaposi Sarcoma, in nearly 20-25% of cases. Lesions in HIV-seropositive subjects prompt as a

diagnostic sign for AIDS. These lesions are bluish-purple macules on the skin, primarily on the

face and lower extremities. Oral mucosa, lymph nodes, and visceral organs can be affected (Arul,

Kumar,Verma, & Arul (2015) .

Intraoral lesions will appear as flat brown to reddish purple macules. Upon examination

and when pressure is applied to them they do not pale in color. In over 90% of cases these

lesions have been found on heavily keratinized mucosa, such as the palate (Bajpai & Pazare

2010). Kaposi Sarcoma can invade bone and in the oral cavity cause tooth mobility when the

palate and or gingiva is affected. These neoplasms can eventually develop into ulcers, nodules,

and masses. Progressive development may diffuse into the surrounding lymph nodes and organ

systems. These lesions can create pain, bleeding, and functional interference caused by the tumor

such as an inability to eat, speak, or swallow.

SYMPTOMS OF AIDS AS SEEN BY DENTAL PROFESSIONALS 7

In one study, it was found that patients with oral lesions were subject to an increased mortality

rate in comparison to those that had only cutaneous symptoms of this disease (Shetty, K. 2005).

AIDS related Kaposi Sarcoma will affect its patients with different degrees of virulence.

Some patients may go through an extensive period of time with little to no physical implications

and others may undergo a more rapid invasive disease that will lead to dissolution of life.

There is no cure for KS, but there are multiple therapies available that if implemented at the

earliest emergence of symptoms can control the size and amount of lesions When there are just a

minimal amount of small lesions, smaller that 1 cm, intralesional chemotherapy is usually

effective(Bajpai & Pazare 2010). This style of treatment has localized benefits, but reoccurrence

is likely, due to inability to eradicate Kaposi Sarcoma lesions in their entirety. The advent of

Antiretroviral medications target the initial HIV infection by reducing viral load and improve

immune function. There are also systemic chemotherapy treatments available to treats visceral

systems affected. More recent developments in the treatment of Kaposi Sarcoma are targeted at

looking into Human Herpes Virus 8, inflammatory cytokines, and the angiogenic environment

needed for the growth KS (Shetty, K. 2005).

CONCLUSION

In concluding this research paper comprehension by dental professionals of the

immunopathogenesis of HIV infection and other oral diseases is of paramount importance. Being

that the oral lesions are the earliest clinical manifestation of HIV (Pakfetrat et al., 2015), the

ability to recognize markers will expedite early diagnosis, treatment and control of these

debilitating manifestations in turn prolonging the lives of AIDS patients.

SYMPTOMS OF AIDS AS SEEN BY DENTAL PROFESSIONALS 8

REFERENCES

Pakfetrat, A., Falaki, F., Delavarian, Z., Dalirsani, Z., Sanatkhani, M., & Zabihi Marani, M.
(2015). Oral Manifestations of Human Immunodeficiency Virus-Infected Patients
. Iranian Journal of Otorhinolaryngology, 27(78), 43–54.

Shetti, A., Gupta, I., & Charantimath, S. M. (2011).

Oral Candidiasis: Aiding in the Diagnosis of HIV—A Case Report.
Case Reports in Dentistry, 2011, 929616. http://doi.org/10.1155/2011/929616

Bajpai, S., & Pazare, A. R. (2010). Oral manifestations of HIV.

Contemporary Clinical Dentistry, 1(1), 1–5. http://doi.org/10.4103/0976-237X.62510

Leao, J. C., Ribeiro, C. M. B., Carvalho, A. A. T., Frezzini, C., & Porter, S. (2009). Oral
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Arul, A. S. K. J., Kumar, A. R., Verma, S., & Arul, A. S. S. J. (2015). Oral Kaposi’s sarcoma:
Sole presentation in HIV seropositive patient.
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Vazquez, J. A. (2010). Optimal management of oropharyngeal and esophageal candidiasis in

patients living with HIV infection. HIV/AIDS (Auckland, N.Z.), 2, 89–101.

Shetty, K. (2005). Management of oral Kaposi’s sarcoma lesions on HIV-positive patient using
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American Cancer Society.(2016) Kaposi Sarcoma. Retrieved From

https://www.cancer.org/cancer/kaposi-sarcoma.html

Moore, J., MPH, Syphard, L., MPH, & Heal, D., MSW. (2014, December)
Know HIV Prevention Education: An HIV and AIDS curriculum manual for healthy
facility employees. (7th ed.). Retrieved from Washington State Department of Health
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