Itin and Lautenschlager (1) reported that viral oral lesions in HIV+ or AIDS patients are common and that HSV-1 and rarely HSV-2 may produce painful and resistant oral ulcers. Systemic treatment with acyclovir, valaciclovir or famciclovir is indicated for those cases and in acyclovir-resistant cases foscarnet is the treatment of choice.
Ceballos-Salobrena et al (2) in a study of the oral manifestations in 396 HIV+ and AIDS patients reported that oral herpes simplex virus lesions were present in 5.30% of the group occupying the fourth place after periodontal disease (78.28%), candidiasis (65.65%) and hairy leukoplakia (16.16%).
The presence of long standing oral ulcers in HIV+ or AIDS patients, due to coinfection with HSV and cytomegalovirus have been previously noted (3,4,5). Recently Flaitz et al (6) reported the findings in 47 persons infected with HIV and having large persistent intraoral ulcers. The most commonly affected sites were:
Mean ulcer size was 1.8 cm and a mean duration of 5.6 weeks. The following viruses were the causative agents for the ulcers:
The diagnosis in all the cases was corroborated with hematoxylin-eosin, periodic acid-Schiff, cytomegalovirus, and HSV immunocytochemical stains. Various treatment modalities were utilized.
Treatment with ganciclovir with or without topical steroids eventuated in resolution of the lesions in the cytomegalovirus and cytomegalovirus/HSV groups, but 23% of these patients had recurrence and/or resistance. HSV/cytomegalovirus ulcers also responded to a combination of oral acyclovir with systemic ganciclovir. When the oral acyclovir dosage was increased, resolution of HSV only ulcers was seen in all but one case. The authors concluded that these lesions responded to systemic antiviral therapy but that they were very difficult to differentiate from other ulcerative diseases, i.e.: major aphthous ulcers, necrotizing stomatitis, and non-specific ulcerations. Glick et al (7) obtained CD4+ cell counts in 454 HIV+ patients and correlated it with specific intraoral lesions present in some of those patients. The corresponding mean CD4+ cell counts and predictive values for long-standing HSV infections were 98.7 cells/mm3 and 87.0%.
The mean CD4+ cell count diminished when the number of different lesions increased. The authors concluded that the presence of specific oral manifestations and the number of different simultaneous intraoral lesions in HIV+ patients are associated with severe immune suppression and AIDS. De Clercq (8) published a comprehensive review of the various medications available for the treatment of primary and recurrent herpetic infections in its different anatomical locations.