Frequent Oral Diseases in HIV Positive and AIDS Patients

Dr. Heddie O. Sedano, DDS

At the end of this lecture, you will be asked if you would like to take this course for continuing education units.
California Continuing Education Credits: 2 units

Other Intraoral Neoplasms

Eighty year-old immuno-compromised HIV negative man, with an exophytic, ulcerated mass on the lateral left side of the tongue. History revealed rapid growth and intense pain. The lesion extended to the floor of the mouth. Biopsy established the diagnosis of squamous cell carcinoma grade III. This fast growing and aggressive carcinomas are also the ones which occur in patients which are HIV infected.

Another squamous carcinoma of the tongue in a malnourished, HIV negative 60 year old man. The lesion was ulcerated and necrotic. There was satellite lymphadenopathy.The diagnosis of squamous cell carcinoma was established after an incisional biopsy was performed.

Squamous cell carcinoma is the most frequent intraoral malignancy in the general population representing 96% of all oral cancers and 5% of all cancers in USA (1). This malignancy has its peak incidence in individuals over 65 years of age followed by persons between 50 and 64 years of age. Intraoral squamous cell carcinoma has been reported quite frequently in HIV positive patients in their third decade of life (1-3). This neoplasm grows rapidly and metastasizes early in the course of its development to regional Iymph nodes. These two characteristics are accentuated in HIV infected patients. Squamous cell carcinoma in AIDS patients develops without pre-existing premalignant conditions such as leukoplakia and erythroplakia and it does not have any apparent relationship to hairy leukoplakia. The most frequently affected site for both AIDS and HIV negative patients is the tongue. This oral cancer may present different clinical appearances such as ulceration and frank exophitic growth. Pain is a common feature especially in the tongue. Regional lymphadenopathy may be evident since the early stages of development. Intraosseous manifestations of squamous cell carcinoma of the head and neck also have been reported (3). As in other malignancies there seems to be co-carcinogenic factors such as heavy smoking, alcohol abuse immune dysfunction and previous radiation therapy (2). The treatment for this malignancy is radiation therapy and/or surgery but the success of these treatment modalities depends on the stage of development of the neoplasm, the histologic grading, the presence of lymph nodes and/or distant metastasis and the general health of the patient. Treatment of this malignancy in AIDS patient has a less favorable prognosis that in HIV negative patients. Squamous cell carcinoma of the conjunctiva and eye lids has been reported with high frequency in AIDS patients (4). A marked increase of this cancer in the cervix and the anorectal region of HIV infected patients also has been reported (5). The development of squamous cell carcinoma in those regions have been linked to the human papillomaviruses, especially 16, 18 and others (6). This finding implies that sexual transmission must be an important factor in the development of this tumor in those areas.

1. Silverman S. Oral Cancer 4th Edition American Cancer Society. Edit. B.C.Decker Inc. Hamilton - London, 1998 pp. 169.
2. Flaitz CM; Nichols CM; Adler-Storthz K; Hicks MJ. Intraoral squamous cell carcinoma in human immunodeficiency virus infection. A clinicopathologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont 1995; 80:55-62.
3. Langford A; Langer R; Lobeck H; Stolpmann HJ; Pohle HD; Reichart P; Bier J. Human immunodeficiency virus-associated squamous cell carcinomas of the head and neck presenting as oral and primary intraosseous squamous cell carcinomas. Quintessence International 1995; 29:635-54.
4. Newton R. A review of the aetiology of squamous cell carcinoma of the conjunctive. Brit J Cancer, 1996; 74:1511-3.
5. Melbye M; Cote TR; Kessler L; Gail M; Biggar RJ. High incidence of anal cancer among AIDS patients. The AlDS/Cancer Working Group.Lancet, 1994; 343(8898):636-9.
6. Garzetti GG; Ciavattini A; Butini L; Vecchi A; Montroni M. Cervical dysplasia in HlV-seropositive women: role of human papillomavirus infection and immune status. Gynecol Obstet Invest 1995; 40:52-6.

Do you wish to take this course for continuing education credit? Yes

Do you wish to take this course for continuing education credit? Yes