Oral Lesions Associated with HIV: Changing Clinical Features in North America and Europe

After over a quarter century of experience with the epidemic of HIV/AIDS in North America and Europe, our understanding of the consequences of this infection for oral health continues to evolve. The prevalence and incidence of oral manifestations of HIV has been demonstrated to be influenced by a number of mutable and immutable factors: gender, transmission behaviors, immune status, viral status, medication use, comorbidities, environmental factors, and other behavioral factors. The dramatic declines in prevalence of oral lesions in the mid 1990’s in developed countries was related to management of HIV disease with highly active antiretroviral therapy (HAART) and the consequent decreases in HIV viremia and improvement in immune status of patients. Additional HAART-induced changes in oral lesion epidemiology relate to the development of immune reconstitution inflammatory syndrome (IRIS). Oral candidiasis remains the most common oral lesion associated with HIV infection in developed countries. Among HIV-associated malignancies, Kaposi sarcoma has become a rare occurrence. The rise in incidence of human papilloma virus-associated oral warts, the aging of adults with chronic HIV-infection, and the cofactors of tobacco and alcohol abuse suggest a potential future increase in incidence of oral squamous cell carcinoma may occur among older adults with HIV infection. Oral candidiasis has been proposed to be a clinical marker of immune failure in patients with HIV/AIDS undergoing HAART. Current and ongoing efforts to document changing features of oral lesions among patients with HIV occurring in developed countries, with advancing medical therapies to manage HIV and its complications, will be discussed.