Noma (cancrum oris) in Human Immunodeficiency Virus Infection (HIV-Infection)

Objectives: To collate the number of cases of noma in HIV-infection in terms of age, gender, year and country of reporting and management reported in the English literature between January 1996 and December 2008.

Methods: An electronic search on Medline with Pubmed for all articles including key words HIV/AIDS and noma (cancrum oris) was carried out and reviewed as per objectives. Articles that did not have the key words together were excluded.

Results: Ten publications (Zimbabwe 3,with one each from Niger,Congo, Burkina Faso, Lesotho, S.Africa, Zambia and Mali) yielded 99 cases, mostly children: 45 females: 24 males (26 children and 4 cases, gender not stated). Standard noma surgical management was done. Early reconstructive surgery was carried out to minimize the grotesque appearance and the HIV-infection stigma. Successful reconstructive surgery was possible despite low CD4:CD8 ratio. No anti-retroviral therapy was available.

Conclusions: Sporadic cases have been reported. This is surprising given the fact that these are the regions hardest hit by HIV-infection. The largest series are from Zimbabwe and Zambia. Female children preponderance and rarity in adults is similar to non-HIV infection related noma.HIV-infection in the children was by mother-to- child transmission with heterosexual transmission in adults. Non-HIV infection related noma is reported to be reaching alarming proportions in the “noma belt” which is concurrently heavily affected by the HIV-infection epidemic. The reported low numbers may be due to poor reporting, lack of awareness of the problem or that some patients die before hospitalisation.