Oral Disease HIV-Management Protocols in North America and Europe

Recently published evidence-based CDC guidelines for the management of oral candidosis may be used to guide treatment decisions. When the CD4 count is less than 200 cells/mm3, systemic antifungal therapy is recommended where available. Due to drug interactions between HAART and systemic antifungal drugs, it is advisable to use topical agents for the treatment of OC in patients with a CD4 count of greater than 200 cells / mm3 as an initial therapy. Treatment of OHL aims at improving cosmetic appearance and/or reducing lesion size and these outcomes should be achievable with minimal associated adverse effects. Topical therapies all require repeated application and recurrence is common after discontinuation. Few studies report the effects of present therapies for multifocal KS on oral lesions. There are potential benefits of intralesional vinblastine and sodium tetradecyl sulphate. At present treatment is mainly palliative and cosmetic. Small lesions of the palate, lips, tongue or buccal mucosa may be surgically resected but if unsuitable for surgery, treatment with repeated intralesonal injections of vinblastine may be appropriate. At present, high quality randomized, controlled trials are not available to develop evidence-based treatment recommendations for the management of HPV-associated lesions in HIV-positive patients. The management of oral warts should be tailored to meet the needs of the individual and also depends on the experience of the healthcare professional and treatment modalities available. The goals of current treatments for HIV-associated recurrent oral ulceration (ROU) are to promote ulcer healing, reduce ulcer duration and pain, while maintaining nutritional intake, and to prevent or diminish the frequency of recurrence. Initial therapy for frequent ROU episodes are topical corticosteroids. Severe ROU responds to immunomodulators including thalidomide 200-400mg/day and levamisole. The vast majority of treatment studies in relation to HIV-associated oral disease originate from resource-rich countries where HIV prevalence is low. Although management protocols for some HIV-related oral diseases exist in North America and Europe, there is a lack of universally accepted outcome measures which leads to difficulties in developing guidelines for effective therapies.