Human Immunodeficiency Virus (HIV) impacts the body’s immune system, progressively diminishing its ability to fight infections. Individuals with HIV often experience various signs and symptoms, many appearing within the mouth. While oral symptoms can indicate immune system changes, their presence alone does not confirm an HIV diagnosis and requires professional medical evaluation. This article describes the visual appearance of these oral signs.
Common Oral Manifestations of HIV
Oral candidiasis, or thrush, is a fungal infection common in individuals with HIV. It typically appears as creamy white, curd-like patches on the tongue, inner cheeks, or the roof of the mouth. These patches can be scraped off, revealing red, inflamed, or bleeding tissue underneath. Patients may experience a burning sensation or altered taste.
Oral hairy leukoplakia presents as white, corrugated, or “hairy” patches, most often on the sides of the tongue. Unlike thrush, these patches cannot be scraped off. Appearance ranges from faint white streaks to a shaggy, furrowed texture. While often asymptomatic, some individuals report discomfort or changes in taste.
Kaposi’s Sarcoma can manifest in the mouth as flat or raised reddish-purple lesions. These lesions are often found on the gums and palate. Color may vary from pink, red, or purple to dark brown or black. These lesions may also ulcerate as they progress.
Aphthous ulcers, or canker sores, are common oral lesions that can be more frequent or severe in individuals with HIV. They are painful, round or oval sores with a white or yellowish center and a distinct red border. These sores often develop on the inner cheeks, lips, or under the tongue. Their presence can cause significant pain, especially when speaking or eating.
Herpes Simplex Virus (HSV) infections, or cold sores, appear as small, painful blisters. These blisters can rupture and form ulcers, commonly found on the lips, around the mouth, or inside the mouth. In individuals with HIV, these lesions may be more severe and persist longer.
Periodontal disease, or gum disease, can progress more aggressively with HIV. It presents as red, swollen, and bleeding gums. Other signs include bad breath and, in advanced stages, potential loosening of teeth. This condition reflects inflammation and infection of the tissues supporting the teeth.
Less Common and Atypical Oral Signs
Non-Hodgkin Lymphoma can appear as a swelling or mass within the mouth or throat, sometimes with ulceration. The palate and gingiva are common sites for these lesions. They can enlarge rapidly and cause severe pain.
Salivary gland enlargement, particularly of the parotid glands, can occur. This enlargement is usually painless and bilateral. Persistent dry mouth (xerostomia) often accompanies this, resulting from reduced saliva production. Dry mouth increases the risk of tooth decay and other oral infections.
Warts, caused by Human Papillomavirus (HPV), may manifest as small, cauliflower-like growths anywhere in the mouth. These growths can be white, pink, or red, and may be flat or slightly raised. They are typically painless and can appear as single lesions or in clusters.
Necrotizing Ulcerative Periodontitis (NUP) is a severe gum disease with painful inflammation, ulceration, and rapid destruction of gum tissue. This condition often involves a foul odor and can lead to significant tissue loss around the teeth.
Why Oral Manifestations Appear
Oral manifestations in individuals with HIV primarily arise from the virus’s impact on the immune system. HIV targets and destroys CD4 cells, essential for coordinating the body’s immune response. As CD4 cell numbers decrease, the immune system weakens.
This compromised function makes the body vulnerable to opportunistic infections that a healthy immune system would normally control. The mouth is particularly susceptible due to constant exposure to diverse microbes, including bacteria, fungi, and viruses. When immune defenses are low, these microbes can overgrow or cause infections, leading to various oral signs.
When to Seek Medical Attention
Individuals should seek medical attention for any new or unusual sores, lesions, or changes in their mouth, including persistent white patches, unexplained redness, swelling, or growths that do not resolve. Consult a healthcare professional if existing oral conditions worsen, become more painful, or do not respond to typical hygiene practices.
Persistent pain, difficulty eating, or swallowing also warrant prompt medical evaluation. If HIV exposure or risk factors are suspected, medical consultation is advised. Early diagnosis and treatment for HIV and its oral conditions are important for managing health and preventing complications. Only a medical professional can provide an accurate diagnosis and recommend care.