Frequent Oral Diseases in HIV Positive and AIDS Patients

Dr. Heddie O. Sedano, DDS

Recent References on Cytomegalovirus Infection

Reed et al (1) reported that CMV retinitis in AIDS patiens regresses with protease-inhibitor treatment without specific anticytomegalovirus medications. This result may be due to a combination of reduced viral load, increase of CD4+ cell count and possible direct drug effect.

Mussini et al (2) presented statistical analysis on various types of CMV infections in AIDS patients, including retinitis, encephalitis and colitis. Itin and Lautenschlager (3) found that CMV was the only ulcerogenic viral agent in 53% of AIDS patients with oral mucosal ulcers. These authors state that cytomegalovirus infection treatment with ganciclovir is helpful. Several authors (4-10) have reported CMV as the etiologic agent in chronic oral ulcers and periodontal disease in AIDS patients. Similar ulcers have been reported in the esophageal mucosas (11).

1. Reed JB; Schwab IR; Gordon J; Morse LS. Regression of cytomegalovirus retinitis associated with protease-inhibitor treatment in patients with AIDS. Amer J Ophthalmol, 1997; 124:199-205.
2. Mussini C; Mongiardo N; Manicardi G; Trenti F; Alessandri A; Paolillo F; Catania A; Portolani M; Pecorari M; Borghi V; et al. Relevance of clinical and laboratory findings in the diagnosis of cytomegalovirus encephalitis in patients with AIDS. Europ J Clin Microbiol Infec Dis 1997; 16437-44.
3. Itin PH; Lautenschlager S.Viral lesions of the mouth in HIV-infected patients. Dermatol 1997; 194:1-7.
4. Regezi JA; Eversole LR; Barker BF; Rick GM; Silverman S Jr. Herpes simplex and cytomegalovirus coinfected oral ulcers in HIV-positive patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont 1996; 81:55-62.
5. Firth NA; Rich AM; Reade PC. Oral mucosal ulceration due to cytomegalovirus associated with human immunodeficiency virus infection. Case report and brief review. Austral Dent J 1994; 39:273-5.
6. Friedman M; Brenski A; Taylor L.Treatment of aphthous ulcers in AIDS patients. Laryngoscope, 1994; 104:566-70.
7. Liang GS; Daikos GL; Serfling U; Zhu WY; Pecoraro M; Leonardi CL; Fischl MA; Penneys NS. An evaluation of oral ulcers in patients with AIDS and AIDS-related complex. J Amer Acad Dermatol 1993; 29:563-8.
8. Dodd CL; Winkler JR; Heinic GS; Daniels TE; Yee K; Greenspan D. Cytomegalovirus infection presenting as acute periodontal infection in a patient infected with the human immunodeficiency virus. J Clin Periodontol 1993; 20:282-5.
9. Epstein JB; Sherlock CH; Wolber RA. Oral manifestations of cytomegalovirus infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont 1993; 75:443-51.
10. Heinic GS; Greenspan D; Greenspan JS. Oral CMV lesions and the HIV infected. Early recognition can help prevent morbidity. JAMA 1993; 124:99-105.
11. Wilcox CM; Straub RF; Schwartz DA.Prospective evaluation of biopsy number for the diagnosis of viral esophagitis in patients with HIV infection and esophageal ulcer. Gastrointestinal Endoscopy 1996; 44:587-93.

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