Frequent Oral Diseases in HIV Positive and AIDS Patients

Dr. Heddie O. Sedano, DDS

Recent References to B-Cell Lymphoma

Knowles (1) reported that the incidence of non-Hodgkin's lymphoma (NHL) is markedly increased in patients with AIDS. Eighty percent of NHL in AIDS patients are systemic, either nodal or extranodal and the remaining 20°h develop as primary CNS lymphomas. Contributing factors in the development of NHL are: HlV-induced immunosuppression, chronic antigenic stimulation and overproduction of cytokine. AIDS associated NHL is characterized by monoclonal B-cells and almost 100% of them contain Epstein-Barr virus (EBV).

Several authors have reported the association of EBV and NHL in AIDS patients (2-5). Gulley et al (4) noted that EBV is shed in the saliva of persons infected with HIV. EBV has been implicated in the pathogenesis of high grade lymphomas which represent the majority of lymphomas arising in oral soft tissues. Therefore, it can be postulated that EBV might be preferentially associated to oral lymphomas.

Lozada-Nur et al (6) concluded that HlV-associated lymphomas have a very agressive behavior and can be clinically mistaken for other tumors or infections. Therefore, an early diagnosis is an important factor i n treatment and prognosis. The most frequent treatments are chemotherapy with or without radiation. The survival rate for the patients in their series was eight months with all the patients dying of complications from their tumors.

Other authors have reported NHL in the oral cavity of HIV infected patients (7, 8) and Palmer et al (9) described a gingival NHL arising in conjuction with HlV-periodontitis. These authors suggest that areas of the gingiva which show localized recession ~n HIV positive patients, should be closely watched and biopsied if unusual s igns and/or symptoms are present.

1. Knowles DM. Etiology and pathogenesis of AlDS-related non--Hodgkin's
2. lymphoma. Hematology/Oncology Clin North Amer 1996;10:1081-109
3. Piluso S; Di Lollo S; Baroni G; Leoncini F; Gagl~oti D; Saccardi A; Ficarra G. Unusual clinical aspects of oral non-Hodgkin lymphomas in patients with HIV infection. European J Cancer. Part B Oral Oncol 1994; 30B:614.
4. Delecluse HJ; Anagnostopoulos l; Dallenbach F; Hummel M; Marafioti T; Schneider U; Huhn D; Schmidt-Westhausen A; Reichart PA; Gross U; et al. Plasmablastic lymphomas of the oral cavity: a new entity associated with the human immunodeficiency virus infection. Blood 1997; 89:141 3- 20.
5. Gulley ML; Sargeant KP; Grider DJ; Eagan PA; Davey DD; Damm DD; Robinson RA; Vandersteen DP; McGuff HS; Banks PM. Lymphomas of the oral soft tissues are not preferentially associated with latent or replicative Epstein-Barr virus.Oral Surg Oral Med Oral Pathol Oral Radiol Endodont 1995; 80:425-31.
6. Thomas JA; Cotter F; Hanby AM; Long LQ; Morgan PR; Bramble B; Bailey BM. Epstein-Barr virus-related oral T-cell lymphoma associated with human immunodeficiency virus immunosuppression. Blood 1993; 81 :3350-6.
7. Lozada-Nur F; de Sanz S; Silverman S Jr; Miranda C; Regezi JA. Intraoral non-Hodgkin's lymphoma in seven patients with acquired immunodeficiency syndrome.Oral Surg Oral Med Oral Pathol Oral Radiol Endodont 1 996; 82:1 73-8.
8. Dodd CL; Greenspan D; Heinic GS; Rabanus JP; Greenspan JS. Multi-focal oral non-Hodgkin's lymphoma in an AIDS patient. Brit Dent J 1993; 1 75:373-7.
9. Nittayananta W; Chungpanich S; Pongpanich S; Mitarnun W. AlDS-related non-Hodgkin's lymphoma presenting as delayed healing of an extraction wound. Brit Dent J 1 996; 1 81:1 02-4.
10. Palmer GD; Morgan PR; Challacombe SJ. T-cell lymphoma associated with periodontal disease and HIV infection. A case report. J Clin Periodontol 1993; 20:378-80.