Pathological changes in the oral cavity, as well as diseases of the oral mucosa are one of the symptoms of the presence of the immunodeficiency virus in the body. However, one should not think that the presence of dental problems may indicate infection with the immunodeficiency virus. To understand how oral diseases are related to HIV infection, it is worth talking in more detail about the immunodeficiency virus and its vital functions.
What is HIV? What is HIV infection
The human immunodeficiency virus, or HIV, was identified and described relatively recently. Invading the human body, it primarily affects macrophage cells and T-lymphocytes, which are responsible for recognizing and destroying hostile bacteria. Thus, the body's immune barrier loses its ability to resist both external bacterial attacks and internal opportunistic flora.
The immunodeficiency virus is transmitted exclusively through sexual contact or through direct contact of a healthy body with infected blood. Transmission of the virus through household or food contact is impossible.
HIV infection is a slow-onset disease caused by a virus and occurs against a background of suppressed immunity. It can take years from the introduction of the virus to the clinical manifestations of the disease. During this entire period, the virus does not manifest itself in any way, and its presence can only be diagnosed using a laboratory method.
HIV and AIDS - differences, duration of development, forecasts
AIDS is the final stage of HIV, which is characterized by severely reduced immunity. It is important not to confuse these two concepts. From the moment of HIV infection, the disease can develop to the AIDS stage without treatment within 9-11 years (on average). Once diagnosed with AIDS without treatment, life expectancy is short - on average up to 19 months.
If you start treatment on time, you can live a very long life at the HIV stage - the life expectancy of such patients thanks to modern treatment is 20-50 years. And although at the AIDS stage the situation is much more complicated, many patients, with proper treatment and a strong body, can live more than 10 years.
It is obvious that taking therapy is the most important factor for treating HIV and living a full, long life. Moreover, it is treatment that can significantly reduce the viral load and make the infected person harmless to the partner, as well as family members.
HIV infection of the oral cavity and its causes
Inflammatory processes in the mucous tissues of the oral cavity are one of the first symptoms of virus activation. This is due to the peculiarity of the structure of the oral cavity and its constant contact with the aggressive external environment. Most often, the mucous membrane is affected by the herpes simplex virus, Candida fungus, Epstein-Barr virus, and papillomaviruses. Bacterial infections are caused by streptococci and staphylococci, which are no longer contained by local immunity. In conditions of immunity suppressed by the virus, periods of remission become shorter, and inflammatory processes are acutely progressive. Timely prescribed additional studies make it possible to correctly prescribe a course of maintenance therapy, since diseases of the oral mucosa are not directly a symptom of HIV infection.
Based on their suspected association with HIV, oral infections are divided into three groups.
Group 1 includes pathologies most closely associated with the immunodeficiency virus:
- candidiasis, colloquially “thrush”;
- hairy leukoplakia (changes in the mucous membrane of the tongue);
- HIV gingivitis (acute inflammation of the gums);
- HIV periodontitis (periodontal inflammation);
- Kaposi's sarcoma (a specific neoplasm on the hard palate of the oral cavity);
- non-Hodgkin's lymphoma.
The 2nd group of diseases includes lesions to a lesser extent, associated with symptoms of HIV infection:
- thrombocytopenic purpura (multiple hemorrhages);
- pathology of the salivary glands;
- viral infections (herpes).
Group 3 includes diseases that often occur with HIV infection, but are not associated with it. Below we will consider diseases from the first group, as the most characteristic of the state of immunodeficiency.
Useful video
From this video you will learn about tongue lesions due to HIV infection:
Unfortunately, today there are no specific means to get rid of HIV infection. However, everyone can do everything they can to reduce the likelihood of infection.
Carefully monitor your own health and try to listen to the signals that your body gives you.
Even such a typical and common ailment as a coating on the tongue can occur as a result of HIV infection.
Symptoms of HIV infection in the oral cavity
The herpes simplex virus is present in most people. The infection persists in the body throughout life and does not cause any special problems, except for rare rashes on the lips.
Herpetic gingivostomatitis
In HIV-infected people, herpes rashes are chronic with rare stages of remission. It is distinguished by blistering rashes around the mouth and on mucous tissues. When the vesicles open, painful erosions occur that develop into fairly large ulcers. The manifestation of herpes zoster and rashes in atypical places is also noticed.
Candidiasis
Candidiasis is also a common symptom of HIV infection and is chronic. Its symptoms are the same as with regular thrush, the only difference being that plaque covers most of the mouth.
Hairy leukoplakia
Clinical manifestations of the disease look like deformed mucous tissue, externally resembling folds or hairs. Localization area: lateral parts of the tongue and the inner surface of the cheeks. Painful sensations are usually absent.
HIV gingivitis and periodontitis
In this case, the infection manifests itself as acute inflammation of the gums. Starting with ordinary bleeding gums, the disease quickly develops into an acute form. With adequate treatment, tooth loss can be avoided.
Kaposi's sarcoma
This is one of the most characteristic symptoms of HIV infection in the clinical stage of manifestation. The tumor is formed from lymphatic vessels, in the mouth it is located near the root of the tongue, less often on the gums.
Candidiasis
Cervical cancer
Diabetes
HIV
Thrush
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IMPORTANT!
The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Candidiasis: causes, symptoms, diagnosis and treatment methods.
Candidiasis is an infectious disease caused by yeast-like fungi of the genus Candida. It is caused by the active proliferation of fungus on the mucous membranes of the oral cavity, genital and internal organs and on the skin.
All representatives of the genus Candida belong to opportunistic microorganisms, that is, they are constantly present in the normal microflora. But with a decrease in immunity, changes in hormonal levels and for a number of other reasons, these fungi can begin to actively colonize the mucous membranes and skin.
The most common members of the genus are Candida albicans and C. tropicalis. In 90-95% of cases of urogenital candidiasis, C. albicans is the dominant pathogen.
The first contact with fungi of the genus Candida occurs during the passage of the child through the birth canal. However, the medical literature describes cases of detection of these microorganisms in amniotic fluid, which indicates the possibility of a vertical (transplacental) transmission route. Transmission of the fungus of the genus Candida also occurs through breastfeeding, skin contact between the child and the mother, and through household and food routes.
These microorganisms produce endotoxins and enzymes that cause cell death and tissue necrosis, which enhances the adhesive (attachment to cells of the mucous membranes or skin) ability of the fungus and ensures penetration into tissue.
Overproduction of these and a number of other substances determines the pathogenicity of representatives of the Candida family.
Causes of candidiasis
- Exogenous (external) factors facilitating the penetration of fungi into the body:
- occupational hazards leading to frequent skin damage;
- prolonged exposure to a warm and humid environment;
- violation of the integrity of the mucous membranes.
- Factors leading to a decrease in the body's resistance:
- presence of chronic diseases;
- long-term use of drugs that disrupt the natural microflora;
- unbalanced diet;
- frequent stress, disturbances in sleep and rest patterns.
Risk factors for developing candidiasis
- Metabolic disorders (hypovitaminosis), diseases of the immune system (HIV infection), endocrine pathologies (diabetes mellitus, etc.).
- Long-term use of certain drugs: hormonal contraceptives, systemic glucocorticosteroids, broad-spectrum antibiotics, cytostatics.
- Long stay or living in an area with high humidity and temperature, comfortable for the circulation of fungal spores in the environment.
Classification of the disease
Based on the localization of the process, the following are distinguished:
- Urogenital candidiasis.
- Candidiasis of the oral mucosa.
- Superficial candidiasis.
- Interdigital candidiasis.
- Candidiasis of periungual ridges and nails.
- Candidiasis of the gastrointestinal tract.
Symptoms of candidiasis
Urogenital candidiasis (UGC)
– a widespread disease: according to medical statistics, about 75% of women of reproductive age have registered symptoms of UGC at least once.
There are acute and chronic forms of urogenital candidiasis, candidiasis of the vulva, vagina and other urogenital localizations.
In some cases, when diagnosing, a clarification is used: complicated or uncomplicated UGC, which reflects the number of exacerbations per year and the severity of the disease. Symptoms of female urogenital candidiasis
- The appearance of white-yellow cheesy or creamy discharge from the genital tract. The intensity of discharge may increase before menstruation, which is associated with changes in hormonal levels.
- Unpleasant sensations, itching in the genital area, often aggravated by sexual intercourse or urination.
- Redness and swelling of the mucous membrane of the vulva and vagina, the presence of damage to the skin of the genital organs (cracks, microtraumas).
- In the chronic course of UGC, dryness of the mucous membranes of the genital tract develops.
Symptoms of male urogenital candidiasis
- Redness, swelling, discomfort in the genital area.
- Whitish discharge of a cheesy structure from the genital tract.
- Pain and burning during sexual intercourse and urination.
Superficial candidiasis
can be erythematous (the main symptom is reddened areas of the skin with a weeping surface) and vesicular (the formation of papules, vesicles and pustules in the affected area - inflammatory elements located in the superficial layers of the skin). The lesion begins with large folds of skin, gradually spreading to other areas of the body. In the depths of the folds, weeping occurs (separation of serous exudate through the smallest defects of the epidermis), a violation of the integrity of the skin contributes to the addition of a secondary infection.
Interdigital candidiasis
localized in the space between the fingers. In this case, redness of the skin is noted, followed by the appearance of bubbles in transparent contents. The disease spreads quickly in close groups (in kindergartens, schools, etc.).
Oral mucosal candidiasis (OCOR)
Oral candidiasis causes discomfort, especially when eating - burning, pain, dryness. Depending on the location of the process, several forms of oral candidiasis are distinguished.
Often, CSOPR and the gastrointestinal tract accompanies immunodeficiency conditions: HIV infection, acquired human immunodeficiency syndrome (AIDS) or congenital immunodeficiency (for example, with T-lymphocyte pathology). In the presence of these diseases, candidiasis occurs with the most severe symptoms, is difficult to treat, and is aggressive in nature.
The most common manifestation of CSOPR is candidal stomatitis, which mainly affects infants and adults with weakened immune systems.
With this pathology, the oral mucosa turns red, swells, and whitish films with a cheesy consistency appear on it. In the initial stages of the disease, plaque is easily removed. As the disease progresses, the films become denser, are difficult to separate, and when removed, the bleeding mucous membrane is exposed.
With candidal stomatitis, the tongue may be affected, which is manifested by redness of the back of the tongue, the appearance of plaque and desquamation of the epithelium. These symptoms are accompanied by severe pain in the affected area when talking, eating, and palpating the tongue.
Smokers, more often than other types of CSOPR, develop chronic hyperplastic candidiasis, accompanied by the formation of white, merging plaques that rise above the surface of the hyperemic mucosa.
With this pathology, the consistency of saliva changes: it becomes viscous and foaming; there is an unpleasant odor from the mouth, a gray or white coating on the mucous membrane. In 10-40% of cases, this clinical form of candidiasis becomes malignant (i.e., becomes malignant).
Older people most often develop a chronic atrophic form of oral candidiasis. The mucous membrane turns red and swells. The lesion is often localized under dentures, which causes pain.
Candidal cheilitis and candidiasis of the corners of the mouth mainly occur in children and the elderly. The lesion is usually bilateral, with the formation of red, painful cracks in the corners of the mouth, covered with an easily removable white coating or scales. With a long course of the disease, a bacterial infection may occur.
Diagnosis of candidiasis
The diagnostic search algorithm for candidiasis of any localization includes taking material from the affected area, followed by microscopy and culture to determine the type of fungus and its sensitivity to antimycotic (antifungal) drugs.
In order to diagnose conditions that lead to a decrease in immunity, a general blood test is used;
Diagnosis for suspected HIV infection
For differentiated diagnosis of HIV infection from similar dental diseases, the following tests are used:
- Blood test for PCR reaction (aimed at detecting HIV).
- Immunoblotting technique.
- Linked immunosorbent assay.
- Checking immune status.
If the results are unclear, additional blood tests, as well as bacteriological studies, may be prescribed. Early diagnosis of the root cause of diseases can significantly alleviate the course of the disease.
Classification of the disease by stages
During the course of the disease, it is customary to distinguish five successive stages. Each of them has its own specific characteristics. Source: Structural biology of HIV. B. G. Turner, M. F. Summers. Howard Hughes Medical Institute and Department of Chemistry and Biochemistry University of Maryland Baltimore County. https://www.sciencedirect.com/science/article /abs/pii/S0022283698923543?via%3Dihub.
The incubation stage lasts from the period when the virus enters the body until a reaction to it appears (in the form of the symptoms described above) or the production of antibodies. The duration of this stage is from 3-4 weeks to 3 months, in rare cases longer. During this period, viral particles actively spread throughout the body and multiply, but there are no clinical manifestations, HIV is not detected by laboratory tests, but the person is contagious.
The stage of primary manifestations begins approximately 3-6 months from the moment of infection. The virus continues to actively multiply during this period, and the immune system actively reacts to its presence by producing antibodies and clinical symptoms. During this period, the infection can be detected by laboratory examination: a specific test for HIV is performed. During this period, there may be no complaints, or periods of low-grade fever, skin rashes, lymph node reactions, candidiasis, relapses of herpes infection, and pneumonia may occur. The duration of acute HIV infection is 12 months from the moment antibodies appear.
The subclinical stage of infection is characterized by a slowdown in the process of virus reproduction and active synthesis of antibodies to existing particles. Among the leading symptoms are enlarged lymph nodes. The duration of the stage is about 5-7 years, sometimes it can extend to 10-20 years.
The stage of secondary diseases is characterized by the constant multiplication of viral particles, the death of the population of CD4 lymphocytes with the gradual depletion of the immune system resource. This leads to the formation of opportunistic infections (candidiasis, tuberculosis, herpes zoster) and oncological processes (Kaposi's sarcoma). The duration of the stage depends on the activity of treatment of secondary pathologies and the characteristics of the immune system.
The AIDS stage completes the development of the infection. Typically, the development of lesions of the nervous system, secondary severe infections and tumors, which pose a threat to life and occur as generalized processes. Without treatment, AIDS occurs approximately 10-12 years after infection.
