Present classification systems for HIV – associated oral lesions
developed in the early 1990’s which was named as HAART. Patterns of oral
conditions keep on changing very frequently. This highlights the need of new
system.
Classification of oral diseases of HIV – associated
immune suppression (ODHIS)
System should consider:
·
Changes in epidemiology of oral lesions
·
Therapeutics
·
Development of lesions and immune systems
·
Oral lesions to oral disease
Definition
of Oral disease: abnormality
characterized by a defined set of signs and symptoms in the oral cavity,
extending from the vermilion border of the lip to the oropharynx, with the
exception of salivary gland disease
New
Classification- Classification of oral diseases of HIV – associated
immune suppression (ODHIS)
Group 1 – ODHIS associated with
severe immune suppression (CD4<200 cells/mm3)
Group 2 – ODHIS associated with
immune suppression (CD4<500 cells/mm3)
Group 3 – ODHIS assumed associated
with immune suppression
A) More commonly observed
B) Rarely reported
Group 4 – Therapeutically-induced
oral diseases
Group 5 – Emerging oral diseases
Oral diseases do not belong exclusively to one
classification Group
Overlap may exist
Use of the New Classification
·
Identifying undiagnosed individuals
·
Provides additional rationale for HIV testing
·
Affects access and type of HIV-related
healthcare
·
Provides clinical markers for therapeutic
interventions and efficacy
Group 1. ODHIS associated
with severe immune suppression (CD4<200 cells/mm3)
1. Major recurrent aphthous ulcer
2. Neutropenia-induced ulcers
3. Necrotizing ulcerative periodontitis
4. Necrotizing stomatitis
5. Cytomegalovirus (CMV)
6. Chronic HSV
7. Histoplasmosis
8. Esophageal, pseudomembranous, and hypertrophic
candidiasis
9. Oral hairy leukoplakia
10.
Kaposi’s sarcoma
11.
Idiopathic Necrotizing Stomatitis
 |
| Hyperplastic candidosis |
 |
| Oesophageal candidosis |
 |
| Pseudomembranous Candidosis |
 |
| Kaposi's Sarcoma |
 |
| Histoplasmosis |
 |
| Periodontitis |
 |
| Neccotizing Sialometaplasia |
 |
| Chronic HSV |
Group 2. ODHIS associated
with immune suppression (CD4,500 cells/mm3)
1.
Major recurrent aphthous ulcer
2.
Increased frequency, harder to treat, atypical
location
3.
Erythematous candidiasis
4.
Salivary gland disease
5.
Drug induced low salivation
6.
Facial palsy
7.
Neuropathies
8.
Hyposalivation
9.
Human papilloma virus (HPV)
10.
Linear gingival erythema
11.
Non-Hodgkin’s lymphoma
12.
Linear Gingival Erythema
 |
| Aptheous Ulcer |
 |
| HPV |
Group 3. ODHIS assumed
associated with immune suppression
More commonly observed
1.
Angular candidiasis
2.
Herpes labialis
3.
Intra-oral herpes
4.
Minor aphthous ulcers
Rarely reported
1.
Bacillary epithelioid angiomatosis
2.
Tuberculosis
3.
Deep-seated mycosis (except histoplasmosis)
4.
Molluscum contagiosum
5.
Varicella Zoster Virus (VZV)
6.
HSV Labialis
7.
Intra-oral Herpes
8.
Minor Aphthous Ulcers
 |
| Angular Chelitis with candidosis |
Group 4.
Therapeutically-induced oral diseases
Side-effect
·
Melanotic hyperpigmentation
·
Ulcers
·
Hyposalivation
·
Lichenoid drug reaction
·
Neutropenia-induced ulcers
·
Thrombocytopenia
·
Lypodystrophy-associated oral changes
·
Perioral paresthesia
·
Steven Johnson’s?
·
Exfoliative cheilitis?
Resistance-induced disease
·
Different Candida spp and strains
·
HSV
Antiretrovirals and Adverse
Reactions
Antiretroviral Drugs
Indinavir
Saquinavir
Amprenavir
Nevirapine
Delavirdine
Efavirenz
Stavudine
Didanosine
 |
| Recurrent HSV |
Adverse reactions of
antiretroviral drugs
Oral ulcers
Stevens Johnson’s
Taste changes
Dryness
Perioral paresthesia
Thrombocytopenia
Ulcers – Medication Induced
Recurrent HSV
Group 5. Emerging oral
diseases
1.
Human papilloma virus, several HPV types (may be
associated with immune reconstitution)
2.
Erythema migrans
3.
Variants of Non-Hodgkin’s Lymphoma (NHL B-cell
types)
4.
Epithelial neoplasms
5.
Aggressive interproximal dental caries
6.
Condyloma Accuminatum
7.
Squamous Cell Carcinoma
No comments:
Post a Comment