ORAL Manifestations OF

HIV INFECTION
IN PEDIATRIC PATIENTS
(Literature Study)
Bagus Soebadi*, Hening Tuti Hendarti, Desiana Radithia
Oral Medicine Department, Faculty of Dentistry, Airlangga University

Introduction

~Background Information~

HIV infection and AIDS are spreading rapidly among the worlds children population, especially those in developing countries. Babies born to HIV-infected
women may become infected before or during birth, or through breast-feeding after birth. Small number of children also have been infected through
sexual abuse by HIV-infected adults.
Oral manifestations are early and may serve as indicators of HIV infection and progression in children, as in adults. Oropharyngeal candidiasis is the most
common sign of HIV infection in children and it corresponds to the progress of this disease. Other common oral manifestations are recurrent aphthous
ulcers, herpes simplex, parotid enlargement, xerostomia, caries and gingivitis.

~Aims~

To give updated knowledge about HIV infection in children by detecting the common oral manifestations, therefore dentists have an important role in making early diagnosis of HIV.
To help dentists to be aware of possible underlying systemic diseases, which one of them is HIV infection.

Literature study
Acquired Immune Deficiency Syndrome or AIDS is a syndrome involving several infections due to the decline of body immune system, caused by Human
Immunodeficiency Virus (HIV).
HIV-infected people tend to progress to full-blown AIDS in approximately 5 to 20 years, but the progress can be delayed by giving Highly Active AntiRetroviral Therapy (HAART).
More than 95% of HIV-infected people living in developing countries develop to AIDS. This might be caused by late detection which leads to late
treatment.
Dentists have an opportunity to discover the suspicion of HIV infection by knowing the common oral manifestations of this disease.
Oral manifestations of HIV infection in children are classified based on the etiology : Fungal, Bacterial, and Viral infection

Oral manifestations commonly found during the 2nd stage of HIV infection :
~Recurrent Aphthous Ulceration~

~Angular cheilitis~

Recurrent aphthae of unknown etiology, on non keratinized

oral mucosa
Clinical appearance :
Painful, small, white ulcer, regular border, with
erythematous surrounding

A mucocut aneous infect ion, caus ed by bot h bacterial and fungal

Clinical appearance :
Deep crack (fi s s ure) on t he angle of t he mouth, involving m ucos a
Might appear as s im ple at rophic eryt hema, or deeper eros ion and even ulceration

taken from : Interactive Atlas of Oral Disease & Oral

Pathology
taken from : University of Stellenbosch

Oral manifestations commonly found during the 3rd

stage of HIV infection :
~Oral Candidiasis~
The most common oral fungal infection in HIV-infected children, commonly caused by the
opportunistic Candida albicans
Clinical appearance :
Drop-like or creamy white patch, easy to scrap off, leaving erythematous or
sometimes erosion on underlying mucosa
Severe infection may extend to oropharynx, commonly found in 4th stage of HIV infection

Oral manifestations commonly found during the 4th

stage of HIV infection :
~Oropharyngeal Candidiasis~
Severe progression of oral candidiasis
Clinical appearance is the same as Oral Candidiasis, extending to pharyngeal mucosa,
causing patient to suffer swallowing difficulties

~Herpes Simplex Infection~

Viral infection caused by Herpes Simplex Virus
Normally is a self-limiting disease, but in HIV-infected children, persistent and unresponsive to treatment, and more frequent period of reactivation as Herpes
Labialis
Clinical appearance :
Crops of vesicles, easily rupture to painful major ulcers with irregular border, with erythematous surrounding, on all parts of oral mucosa

taken from : University of Stellenbosch

taken from : University of Stellenbosch

Discussion

Conclusion

Oral manifestations correlate to patients immunosuppressive condition.

Stage 1 The condition is asymptomatic and no oral manifestations present. Patients look healthy,
although suffering mild infections such as flu-like syndrome.
Stage 2 CD4+ count drops between 200 500 cells/mm3. Patients begin to suffer moderate
infections which are more persistent or recurrent, and often unresponsive to standard treatment
Stage 3 and 4 CD 4+ count drops below 200 cell/mm3.
Having reached this stage, the infection progresses rapidly to AIDS.
Oropharyngeal candidiasis often found in this stage.
Oral lesions might be an indicator of HIV infection
OralCandidiasis is the most common manifestation which often indicates full-blown AIDS
Xerostomia causes patients susceptible to infections and caries

Oral manifestations play a role as an

indicator of HIV infection.
They are also suggested to indicate
the status of CD4+ level which
correlates with the disease
progression.
Dentists, especially Pediatric Dentists,
should be able to recognize these
common oral lesions leading to
suspicion of HIV infection.

All infections in HIV-infected children more are more severe than non HIV-infected children
*Correspondence : b.soebadi@gmail.com

Manifestasi infeksi HIV Pada rongga mulut

Oleh : drg Astrid Marinna Sp.PM

PENDAHULUAN
APA ITU AIDS
Aids singkatan dari Aquired Immune deficiency syndrome.
Penyebab: Human Immunodeficiency Virus (HIV)
Definisi : sekumpulan gejala penyakit yang timbul dimana sistem imun tubuh tidak mampu melawan disebabkan
oleh infeksi HIV.
Aids dan misterinya
Semua Orang Bisa Terkena AIDS
Belum Ada Vaksin Pencegahannya
Belum Ada Obatnya
Penyebaranya Sangat Cepat
Pengetahuan tentang AIDS adalah langkah pertama untuk pencegahan penyebaran AIDS lebih meluas

CARA PENULARAN
1.
2.

Hubungan seksual yang tidak aman

Melalui aliran darah :
-Pemakaian jarum suntik tidak steril/
bergantian / IDU
- Transfusi darah
- Tranplantasi organ
3. Ibu ke anak : 50 % anak terjangkit HIV saat lahir

Tidak
menular
melalui

Manifestasi infeksi HIV pada rongga mulut

~Recurrent Aphthous Ulceration~

~Angular cheilitis~
Infeks i mukokutan yang dis ebabkan oleh bakt eri m aupun jam ur
Gambarab klinis :
Luka s eperti ret akan yang dalam ( fi ss ure) pada sudut mulut
Luka mudah berdarah dan s akit

taken from : University of Stellenbosch

Orang awam menyebutnya sebagai Sariawan,

Gambaran klinis
Luka / ulser dengan diameter bervariasi, single atau ,
berkelompok, berwarna putih dengan tepi yang jelas,
dikelilingi eritema atau warna merah, dan sakit.

Sarkoma kaposi
Merupakan tumor pembuluh darah yang mempunyai
manifestasi klinis mulai dari yang bentuk plak sampai
nodul / tumor

~Oral Candidiasis~
Infeksi yang paling sering timbul pada pasien HIV yang umumnya disebabkan oleh karena fungi
atau jamur caused Candida albicans
Gambaran klinis:
Bentukan lesi seperti krim susu yang mudah dikelupas/ dikerok dengan meninggalkan area
yang berwarna merah bahakan eritema.
Pada kasus yang parah, infeksi ini menyebar sampai daerah orofaring (stage IV pada infeksi
HIV)

~Infeksi Herpes Simplex

Infeksi virus disebabkan oleh Virus
Infeksi Herpes Simplex merupakan penyakit yang dapat sembuh tanpa pengobatan, namun pada kasus HIV, infeksi ini menetap dan tidak respon terhadap obat, dan dapat muncul
berulang dengan infeksi yang lebih serius yang disebut sebagai herpes labialis
Gambaran klinis:
Vesikel, yang mudah pecah, muncul sebagai ulser atau disebut sariawan yang mengelompok, dengan tepi yang tidak teratur, dikelilingi daewrah kemerahan, denganrasa sakit yang
hebat

taken from : University of Stellenbosch

Non hodgkin lymphoma

Dicurigai disebakan oleh virus EBV (epstebain ), dengan lesi seperti tumor yang timbul dengan cepat dan agresif
Gambaran klinis:
lesi nodul/ tumor dengan diameter lebih dari 2 cm, berdungkul dungkul, mudah berdarah, palpasi/ perabaan keras, mendesak gigi sekitar, disertai rasa sakit

kesimpulan
- Infeksi HIV serta derajat
keparahannya dapat diketahui
melalui manifestasi pada
rongga mulut
-Periksa dan berkonsultasilah
dengan dokter gigi khususnya
spesialis Penyakit Mulut.
-Hidup sehat dan jauhi seks
bebas dan narkoba dapat
menghindarkan dari HIV