Spectrum of oral manifestations of HIV/AIDS in the Perm region (Russia) and identification of self-induced ulceronecrotic lingual lesions

GILEVA OS, SAZHINA MV, GILEVA ES, EFIMOV AV, SCULLY C. SPECTRUM OF ORAL MANIFESTATIONS OF HIV/AIDS IN THE PERM REGION (RUSSIA) AND IDENTIFICATION OF SELF-INDUCED ULCERONECROTIC LINGUAL LESIONS. MED ORAL 2004;9:212-5.

SUMMARY

-Objective: to study the frequency and spectrum of oral manifestations of HIV-infected drug-users in the Perm region.
-Subjects: 104 seropositive HIV-infected drug-users (69 male, 35 female ; ages15 to 32 years; 13 co-infected with hepatitis viruses) and 13 AIDS-infected drug-users (7 male, 6 female ; ages16 to 37 years; 12 co-infected with hepatitis viruses).
-Results: the most frequent forms of oral mucosal lesions in the HIV-infected group - candidiasis (32.7%), herpetic lesions (15.4%), cheilitis glandularis (3.9%), recurrent aphthous stomatitis (2%). Regional lymphadenopathy was observed in 31% cases. The ulceronecrotic oral mucosal lesions were seen in the sublingual region and tongue in 11.5% patients and manifested with pain, dysarthria, dysphagia, and dysgeusia. These lesions were found in drug-users who injected the opioids sublingually.
AIDS patients had oral candidiasis (84.6%), herpetic lesions (53.8%), recurrent aphthous stomatitis (15.4%) and cheilitis glandularis (7%). All AIDS-patients had severe xerostomia, and 15.4% had unilateral or bilateral swelling of the parotid glands. Generalized ulceronecrotic gingivostomatitis was found in 50% of the patients but the sublingual ulceronecrotic lesions were not identified.
-Conclusions: 1. The spectrum of oral cavity lesions of HIV/AIDS patients in Perm region is widespread enough. 2. Dissemination of oral cavity lesions is increasing in proportion of disease progression. 3. Dental care of HIV/AIDS patients should include periodic oral examinations to monitor their disease progression and to alleviate symptoms of oral opportunic and neoplastic diseases, to improve the life-style of the patients infected with HIV.

Key words: HIV-infected drug-users, AIDS-infected drug-users, oral mucosal lesions, candidiasis, herpetic lesions, xerostomia, ulceronecrotic lesions.

INTRODUCTION

The manifestations of HIV/AIDS are common in the head, neck and oral cavity and include opportunic infections, neoplasms and diffuse reactive adenopathy. Some type of oral disease occured as the first clinical signs of HIV infection are important indicators in HIV staging and the stage of immunosupression (1-3).

For the patients oral lesions can cause pain and discomfort, loss of taste and xerostomia, leading to decreased quality of live, some of them can become life-threatening (4,5).

The spectrum of oral manifestations of HIV infection depends on the stage of immunosupression, the way of contamination and some ethnic, geographical, social and demographic factors in concrete region (6,7).

The current epidemic of the acquired immunodeficiency syndrome (AIDS) first reported in Russia in 1987 has been increasing progressively in many country regions and has become a matter of great concern among Russian dental health professionals because of diagnostic problems and potential for transmission.

Perm is one of the largest industrial cities of Russia with a population of > 1 million. By the end of October 2002 the cumulative number of recorded HIV-infected people living in the region amounted to 4020 persons, 90.8% being drug abusers, 87.0% aged 15-25 years, with a male: female ratio of 2.2. The drug usage is typically of home-made opioids using shared injection syringes with the drug often injected in non-typical places such as the tongue or sublingual region.

MATERIAL AND METHODS

We have examined the frequency and spectrum of oral manifestations of HIV-infected drug-users from 1998 to 2002 in Perm region. The group consisted of 104 seropositive HIV-infected drug-users (69 male, 35 female ; ages15 to 32 years; 13 co-infected with hepatitis viruses) and 13 AIDS-infected drug-users (7 male, 6 female ; ages16 to 37 years; 12 co-infected with hepatitis viruses) interviewed and examined by dental surgeons and physicians. Examination of the oral cavity and oropharynx was performed according to WHO recommen-dations (8) and lesions were fixed according to WHO recording form for oral lesions possibly related to HIV infection (1991). Of the 13 HIV-infected patients, 4 had hepatitis B virus (HBV) and 9 had HBV and hepatitis C virus (HCV), while the 12 AIDS patients had HBV plus HCV.

RESULTS

The most frequent form of oral mucosal lesions in the HIV-infected group was candidiasis (clinical and cultural positive) - seen in 32.7%, often as the acute pseudomembranous form, typically as white surface plaques in the buccal mucosa and tongue, or as angular stomatitis. Herpetic lesions were found in 15.4% cases (acute herpetic stomatitis in 31.3%; recurrent labial herpes in 68.7%). Significant xerostomia was noted in 14.4% and regional lymphadenopathy was found in 31.0% of HIV patients. A purulent form of cheilitis glandularis was seen in 3.9% of HIV-infected drug abusers and recurrent aphthous stomatitis was seen in 2% (2 HIV-infected patients).

In contrast with other studies, ulceronecrotic lesions were seen in the sublingual region and tongue in 11.5% patients and manifest with pain, dysarthria, dysphagia, and dysgeusia. Most had a large single unilateral ulcer, with regional lymphadenitis. The tongue surface was deformed, with a middline shift and tremor was present. These lesions were found in drug-users who injected the opioids in the tongue or sublingually, a technique which, according to the patients histories gives more rapid onset of drug effects and promotes a specific range of narcotic feelings.

The most frequent combination of oral mucosal lesions in the HIV-patients was of pseudomembranous candidiasis, relapsing herpes labialis, sublingual ulceronecrotic ulcers and xerostomia.

In the patients with AIDS, all the above forms of mucosal pathologies were seen but the frequency was increased 2-2.5 times. Thus 84.6% had oral candidiasis; 53.8% had herpetic lesions (and these were mainly herpes zoster ). Recurrent aphthous stomatitis was seen in 15.4% (2 AIDS-patients), and cheilitis glandularis in 7% (1 patient). All AIDS-patients had severe xerostomia, and 15.4% had unilateral or bilateral swelling of the parotid glands. Generalized ulceronecrotic gingivostoma-titis was found in 50% of the patients but the sublingual ulceronecrotic lesions were not identified.

Interestingly, in no cases of HIV/AIDS patients were found such typical diseases, as hairy leukoplakia, condyloma acuminata, verruca vulgaris, Kaposi's sarcoma or non-Hodgkin's lymphoma.

CONCLUSIONS 

1. The spectrum of oral cavity lesions of HIV/AIDS patients in Perm region is widespread enough.

2. Dissemination of oral cavity lesions is increasing in proportion of disease progression.

3. Dental care of HIV/AIDS patients should include periodic oral examinations to monitor their disease progression and to alleviate symptoms of oral opportunic and neoplastic diseases, to improve the life-style of the patients infected with HIV.

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