HIV infection compromises the immune system, making the body unable to effectively fight off various pathogens. This immune deficiency allows opportunistic infections to thrive, particularly in areas lined with mucous membranes. The oral cavity and the pharynx, or throat, are common sites for these visual manifestations, sometimes serving as early indicators of changing immune status. While these signs are not exclusive to HIV, their persistence or severity is an important clue for healthcare providers regarding a person’s overall health.
The Most Common Visual Sign: Oral Thrush
The most frequently seen sign in the mouth and throat is Oral Candidiasis, commonly known as thrush. This fungal infection is caused by the overgrowth of Candida albicans, a yeast normally present in the mouth but kept in check by a healthy immune system. When immunity is suppressed, the fungus multiplies rapidly, leading to distinct lesions.
The classic appearance, known as pseudomembranous candidiasis, involves creamy white or yellowish patches on the inner cheeks, tongue, palate, and extending into the throat. These soft, slightly raised patches can resemble cottage cheese. A defining characteristic is that these lesions can often be gently scraped off, revealing raw, red, and sometimes bleeding tissue underneath.
Another form, erythematous candidiasis, presents as flat, red, raw-looking patches, usually found on the roof of the mouth or the top of the tongue. These areas may cause a burning sensation or taste distortion, especially when eating spicy or acidic foods. The presence of either form of candidiasis is a strong indicator of immune suppression in the context of HIV infection.
Other Notable Oral and Throat Conditions
Beyond candidiasis, several other signs can manifest in the oral and pharyngeal areas. These conditions include persistent ulcers, a distinct white lesion called Oral Hairy Leukoplakia (OHL), and the vascular tumors of Kaposi’s Sarcoma (KS).
Oral ulcers, often appearing as painful, recurring sores similar to canker sores, can affect the soft palate, throat, or base of the gums. In people with advanced immune suppression, these sores can be significantly larger than one centimeter, last much longer, and appear crater-like with elevated borders. These severe ulcers are covered with a whitish-yellow membrane and surrounded by a red ring.
Oral Hairy Leukoplakia (OHL) is a white lesion with a characteristic corrugated or “hairy” texture, almost exclusively found on the sides of the tongue. This non-removable patch is caused by the Epstein-Barr virus (EBV) and signifies a weakened immune response. OHL is strongly associated with HIV, often appearing before other severe complications of immune deficiency.
Kaposi’s Sarcoma (KS) is a less common but serious manifestation, appearing as a tumor of the blood vessel walls. In the mouth, these lesions typically present as flat or slightly raised spots that are purple, reddish, or brownish in color. The hard palate is the most frequent intraoral site, but they can also be found on the gums or pharynx. These vascular tumors are caused by the Human Herpesvirus-8 (HHV-8).
When These Symptoms Appear
The timing of these oral and pharyngeal symptoms is closely linked to the progression of HIV infection, reflecting the severity of immune system compromise. Some symptoms may appear very early, during the acute or primary infection stage, which occurs within a few weeks of exposure. During this period, the body can experience a severe sore throat and painful mouth sores, often mimicking a severe case of the flu or infectious mononucleosis.
Opportunistic infections, such as oral candidiasis, OHL, and KS, are far more common as the disease advances and the count of CD4+ T-cells drops. Oral thrush, for instance, is much more likely to occur when the CD4 count falls below 200 cells/mm³, indicating significant immune damage. The persistence, recurrence, and severity of these oral signs are a direct reflection of how well the immune system is managing the infection.
Treating and Managing Oral Manifestations
Management of these oral and throat manifestations focuses on treating the specific infection while simultaneously addressing the underlying immune deficiency. The most effective strategy for preventing and resolving most opportunistic oral infections is to optimize Antiretroviral Therapy (ART). ART strengthens the immune system, allowing the body to naturally suppress the pathogens that cause these lesions.
For oral candidiasis, treatment involves antifungal medications, such as medicated mouth rinses, lozenges, or systemic tablets like fluconazole. Ulcers and inflammation are managed with topical pain-relieving gels, antiseptic mouthwashes, or, in severe cases, topical corticosteroids to reduce inflammation. Lesions like OHL and KS are typically managed by ensuring the HIV infection is well-controlled with ART, which often leads to the shrinkage or resolution of the lesions. Seeking regular medical and dental check-ups is necessary to monitor oral health and ensure persistent or worsening symptoms are addressed immediately.