Frequent Oral Diseases in HIV Positive and AIDS Patients

Dr. Heddie O. Sedano, DDS

Recent References to Kaposi Sarcoma

Recent studies by various authors (1-5) have reported the presence of the human herpesvirus 8 (Kaposi sarcoma associated herpes virus KSHV) in the saliva of patients with Kaposi sarcoma as well as in the saliva and tissue specimens of Kaposi sarcoma from patients infected with HIV. These studies have been done with polymerase chain reaction and also innoculating cells in tissue culture with cell-free saliva fluid from patients with Kaposi sarcoma. DNA sequencing from human herpesvirus 8 was detected after 13 passages of the cells in tissue culture. This result indicates that infectious KSHV can be present in patients with KS.

Syndikus et al (6) have developed a high dose Microselectron brachytherapy technique for the treatment of oral KS by constructing a customized dental plate with afterloading tubes. They treated seven KS in six patients with a median surface dose of 24 Gy (range 14-39.9 Gy) in 3 fractions over 3 to 10 days. They report complete response for all lesions and the patients exhibited only mild mucositis with no relapse in the treated areas.

Several authors (7-9) have reported the effectiveness of the treatment of small to medium size intraoral KS with intralesional injections of 0.1 mg/cc of vinblastine. McCormick (7) reported that 40% of lesions required only one injection, 31% two and 29% three injections, while large exophitic lesions needed multiple injections. Flaitz et al (8) in a larger series of patients reported complete resolution of the lesions in 74% of the cases with a mean reduction in lesional area of 93% for all lesions. The recurrence rate was 26% with a mean disease-free period of 12.9 weeks. The larger the lesion the greater the recurrence rate.

Lucatorto and Sapp (10) were the first to report the treatment of oral KS with the sclerosing agent sodium tetradecyl sulphate (Sotradecol). They proposed this treatment for lesions no greater than 2.6 cm in diameter by means of intralesional injections of 0.1-0.2 ml. of Sotradecol per square centimeter of lesion. This treatment produces some degree of ulceration of the lesions by the first week with healing starting by the middle of the second week. No recurrences were noted after 18 months or longer of follow-up.

Flaitz et al (11) reported that in up to 60% of patients with AIDS the oral cavity is the initial site of KS. The treatment of oral KS does not greatly modify the prognosis or the survival rate of patients with AIDS but it alleviates pain as well as respiratory and masticatory functions.

Reichart et al. (12) reported that in 124 patients with oro-facial KS the average survival rate was 1 year 9 months with a range of 3 months to 4 years and 6 months. Kaposi sarcoma can be superimposed to preexisting periodontal disease in patients with AIDS (13,143. It is recommended that both lesions be treated at the same time by means of local and systemic therapy in order to obtain the best results.

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2. Koelle DM; Huang ML; Chandran B; Vieira J; Piepkorn M; Corey L. Frequent detection of Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8) DNA in saliva of human immunodeficiency virus-infected men: clinical and immunologic correlates. J Infec 1997;176:94-102.
3. Flaitz CM; Jin YT; Hicks MJ; Nichols CM; Wang YW; Su IJ. Kaposi's sarcoma-associated herpesvirus-like DNA sequences (KSHV/HHV-8) in oral AlDS-Kaposi's sarcoma: a PCR and clinicopathologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont 1997; 83:259-64.
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