Frequent Oral Diseases in HIV Positive and AIDS Patients

Dr. Heddie O. Sedano, DDS

Recurrent Herpes Simplex

Recurrent herpes simplex, also known as recurrent herpes labialis (cold sores) can develop on the lips, generally at the junction of the vermilion and the skin, or in the oral cavity. Intraorally it develops in keratinized mucosa mostly the palate and also on the gingiva. It begins as a burning sensation followed by small coalescing vesicles, which rupture, leaving areas of ulceration surrounded by a erythematous halo. These lesions can be very painful. The lip lesions generally crust and heal within 10 to 14 days without scar formation. Recurrent episodes may vary from one to several a year. Herpes virus type 1 (HSV1) is most frequently responsible for recurrent lesions in HIV+ patients occasionally HSV2 is also found. The recurrent lesions in these patients are generally in the form of large intraoral ulcers which take a long time to heal. These ulcers can be hemorrhagic and occasionally may be covered by a yellowish pseudomembrane. Patients with advanced HIV disease may present several recurrences a year especially characterized by large confluent and extremely painful ulcerations. Several viral studies have demonstrated that ulcers of this type in some HIV+ patients are caused by a combination of HSV1 and cytomegalovirus.

Recurrent herpes simplex secondarily infected in a HIV- man. Note the vesicles which have coalesced. Also note the erythematous halo around the lesions on the skin.	Another recurrent lip lesion covered with a yellowish pseudomembrane also in a HIV- man.
Recurrent intraoral lesions tend to occur with greater frequency in the keratinized mucosas specially on the palate as in this case (HIV-). Palatal lesions are painful and as a rule, in HIV- patients, resolve within 10 to 14 days.	This HIV+ patient presented this large ulcer on the right buccal mucosa of several weeks duration. Biopsy and special viral studies demonstrated the presence of HSV1.

Recurrent herpetic infection is commonly seen in patients with AIDS and. its severity dictates the treatment.

• Rx: Acyclovir capsules 800 mg
• Disp: 56 capsules
• Sig: One capsule four times per day

Chronic suppresive therapy for those patients with frequent recurrences:

• Rx: Acyclovir capsules, 200 mg
• Disp: 50 capsules
• Sig: Two capsules 5 times per day

Topical acyclovir seems to be ineffective in the treatment of recurrent herpetic intraoral and lip lesions. Intravenous medication with acyclovir or if there is acyclovir resistance, with intravenous foscarnet (Foscavir) is also utilized in severe cases. Both these medications need to be administered and controlled by a physician.

Primary herpetic infection
References relevant to herpes simplex (with abstracts)

Classification