Oral Lesions in HIV Infection – Classification and Groups

Oral Lesions are associated with most of the systemic conditions seen due to Bacterial or Viral infections. Many of the Oral lesions are helpful in providing Diagnosis of a Systemic condition and in case of HIV the Oral lesions can help in determining the stage of HIV or AIDS (Acquired Immunodeficiency Syndrome) is in. The Oral lesions which are seen in HIV infection affect the patients daily life as it makes it difficult to Eat, drink and practically do anything. The lesions which are seen in HIV infections are helpful in determining the progression of the disease and in turn showing the immunosuppression.

AIDS or Acquired Immunodeficiency Syndrome is caused by Human Immunodeficiency Virus and the main characterization of the disease is Immunosuppression which in turn leads to infection of the body by other opportunistic infections such as Bacterial, Viral and Fungal leading to secondary infections. There are two types of HIV Virus – HIV -1 (Central Africa) and HIV -2 (West Africa and India) which affect the humans based on geographic locations.  

Classification of Lesions associated with HIV Infection:

Lesions associated with HIV infection is divided into 3 Groups based on the association with HIV infection. The classification is prepared based on two criteria – Presumptive criteria: Relates to the initial appearance of the lesion and Definitive criteria: Result of special investigations for absolute diagnosis. 

Classification of Oral lesions in HIV Infection or AIDS

Group 1: Lesions strongly associated with HIV Infection

  • Candidiasis: Erythematous, Pseudomembranous
  • Periodontal Disease: Linear gingival erythema, Necrotizing ulcerative gingivitis, Necrotizing ulcerative periodontitis
  • Hairy Leukoplakia
  • Kaposis Sarcoma
  • Non-Hodgkin’s lymphoma

Group 2: Lesions less commonly associated with HIV infection

  • Bacterial infections: Mycobacterium avium-intercellulare, Mycobacterium Tuberculosis
  • Necrotizing ulcerative stomatitis
  • Melanotic hyperpigmentation

Group 3: Other Lesions seen in HIV Infection

  • Bacterial infections: Actinomyces israelii, Escherichia coli, Klebsiella pneumonia, Cat Scratch disease
  • Drug Reactions – Ulcerative, erythema multiforme, Lichenoid reaction, toxic epidermolysis
  • Fungal Infections – Cryptomycosis neoformans, Geotrichum candidum, Histoplasma capsulatum, Mucormycosis or zygomycosis, Aspergillus flavus
  • Epitheloid angiomatosis
  • Neurological disturbances: Facial palsy, Trigeminal neuralgia
  • Recurrent Apthous Stomatitis: Viral, Cytomegalo virus, Molluscum contagium

 The Oral lesions are also associated with the treatment plan decided in case of HIV infections, they decide the entry criteria and endpoints for prophylaxis therapy and vaccine trials for the disease. In 1995 European Commision Clearinghouse on oral problems related to HIV infection and the WHO Collaborating Center of oral manifestations of the immunodeficiency virus released the Classification. 

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