The majority of investigators (1-3) have found that oral ulcerations in HIV positive or AIDS patients are produced by a variety of causative agents among them herpes virus 1 and 2, cytomegalovirus, histoplasmosis, criptococcosis, mycobacterium and others. In nearly 50% of the patients a causative agent for these ulcers can not be found. The differential diagnosis, specially of the major ulcers, should include neoplasias such as B cell lymphoma.
Friedman et al (4) reported a total of 240 patients with oral ulcers, 204 with minor ulcers and 36 with major ulcers. In 180 patients of the minor ulcer group the ulcers resolved in less than 2 weeks without treatment. The remaining 24 patients in this group were culture positive for herpes simplex virus, Cryptococcus organisms, cytomegalovirus, or Mycobacterium organisms and were treated accordingly. The 36 patients with major ulcers were treated with intralesional injection with triamcinolone acetonide and examined weekly. All patients manifested pain relief within two days of the first injection. If needed the ulcers were re-injected every two weeks. Most patients had reduction in size of the ulcers and eventual healing. Recently Jacobson et al in a double blind study used thalidomide for the treatment of major oral ulcers in patients with human immunodeficiency virus infection. The patients received a four-week course of either 200 mg of thalidomide or placebo orally once per day and they were evaluated weekly for the condition of the ulcers as well as for evidence of toxicity. Sixteen of 29 patients in the thalidomide group (55 percent) had complete healing of their aphthous ulcers after four weeks, as compared with only 2 of 28 patients in the placebo group. In 6 of the 29 patients the treatment was discontinued because of toxicity. Somnolence was seen in seven patients and rash in another seven. The authors concluded that thalidomide is an effective treatment for aphthous ulceration of the mouth and oropharynx in patients with HIV infection
1. Liang GS et al. An evaluation of oral ulcers in patients with AIDS and AIDS-related complex. J Amer Acad Dermatol 1993; 29:563-8.
2. Piluso et al. Cause of oral ulcers in HIV-infected patients: a study of 19 cases. Oral Surg Oral Med Oral Pathol Oral Radiol and Endod 1996; 82:166-72.
3. Flaitz CM; Nichols CM; Hicks MJ. Herpesviridae-associated persistent mucocutaneous ulcers in acquired immunodeficiency syndrome. A clinicopathologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81:433-41.
4. Friedman M; Brenski A; Taylor L. Treatment of aphthous ulcers in AIDS patients. Laryngoscope, 1994; 104:566-70.
5. Jacobson JM et al. Thalidomide for the treatment of oral aphthous ulcers in patients with human immunodeficiency virus infection. National Institute of Allergy and Infectious Diseases AIDS Clinical Trials Group. New Engl J Med 1997; 336:1487-93.