Oral manifestations of HIV/AIDS are conditions affecting the mouth, including the tongue, in individuals with HIV. These conditions can indicate disease progression or the status of an individual’s immune system.
Common Oral Symptoms on the Tongue
Oral candidiasis, or thrush, is a common fungal infection on the tongue in individuals with HIV/AIDS. It appears as white, creamy patches that wipe away, revealing red, inflamed tissue underneath. These patches can also be found on the inner cheeks and roof of the mouth, sometimes causing a burning sensation and pain when swallowing.
Oral hairy leukoplakia presents as white, corrugated, or “hairy” lesions, primarily on the sides of the tongue, that cannot be scraped off. This condition is linked to the Epstein-Barr virus and often indicates a weakened immune system. While usually asymptomatic, it can occasionally cause discomfort or taste changes.
Kaposi’s sarcoma appears as flat or raised lesions on the tongue, gums, or palate, colored purplish, red, or brown. This vascular tumor is caused by human herpesvirus 8 (HHV-8) and is considered an AIDS-defining illness, signifying an advanced stage of HIV. These lesions may not initially cause pain but can impact eating, swallowing, or speaking if they develop in the mouth or throat.
Aphthous ulcers, or canker sores, are painful, small, round sores that can occur on the tongue, inner cheeks, lips, or soft palate. While not exclusive to HIV, people with HIV may experience them more frequently and severely. These sores typically appear red with a gray or white center.
How HIV Weakens Oral Defenses
HIV targets and destroys CD4+ T cells, a type of white blood cell crucial for a healthy immune response. As HIV replicates, it infects these cells, leading to a gradual decline in their numbers. This reduction compromises the body’s ability to fight off infections and diseases.
A weakened immune system makes individuals susceptible to opportunistic infections and conditions that a healthy immune system would normally control. For instance, oral candidiasis is an opportunistic fungal infection that flourishes when the immune system cannot keep the Candida fungus in check. Oral hairy leukoplakia, caused by the Epstein-Barr virus, also becomes more prevalent with immune suppression.
Some oral conditions, such as Kaposi’s sarcoma, are linked to co-infections with other viruses, like human herpesvirus 8 (HHV-8), and are directly influenced by the immune dysregulation caused by HIV. The presence of these oral manifestations often signifies a decline in CD4+ T-lymphocyte levels and an increase in the viral load, acting as indicators of disease progression.
Recognizing and Addressing These Symptoms
Any suspicious oral symptoms, particularly for individuals at risk of or living with HIV, warrant professional medical evaluation. Self-diagnosis is not sufficient; a healthcare professional, such as a doctor or dentist, should be consulted for proper assessment. Oral lesions can be early indicators of HIV infection, sometimes appearing before an individual is aware of their status.
Diagnosis of these oral conditions typically involves a visual inspection and a review of medical history. In some cases, a biopsy or laboratory tests might be necessary to confirm the diagnosis. For example, a microscopic examination of tissue can confirm thrush.
Treatment strategies for oral manifestations often involve addressing the specific oral condition and managing the underlying HIV infection. Oral candidiasis, for instance, is commonly treated with antifungal medications, such as fluconazole. Oral hairy leukoplakia, while often not requiring specific treatment due to its benign nature, may be managed with antiviral medications or topical agents. For Kaposi’s sarcoma, treatment depends on its extent and may involve local therapies like radiation or intralesional chemotherapy, or systemic chemotherapy for more widespread disease.
Managing the underlying HIV infection through antiretroviral therapy (ART) is crucial, as it helps restore immune function and can lead to the improvement or prevention of many oral manifestations. Early diagnosis and timely management of both the oral symptoms and the HIV infection are important for overall health and quality of life.