Oral Mucosal Diseases in HIV-Infected Russians on HAART

1Department of Oral Medicine, Perm State Academy of Medicine, Perm, Russia. 2Sverdlovsk Regional Center of prophylaxis and fight against AIDS, Ekaterinburg, Russia

Objective: To determine the spectrum of oral mucosal lesions (OML) in a large cohort of Russian HIV-infected patients before and after two-years HAART and to compare the efficacy of two treatments of ulcerative OML (necrotizing ulcerative gingivitis and periodontitis, non-specific self-induced ulcers after intralingual opioid injections in IDU).

Methods: The cohort comprised of 356 HIV-infected IDU before and 224 after two-years HAART. 48 HIV-patients with ulcerative OML were randomized into 2 groups according to the type of local antimicrobial treatment: Bacteriophage - Sextophage (Biomed, Russia) or Corsodyl (GSK, UK) mouthrinse. Both medications were administered locally twice daily over 2-3 weeks. Treatment efficacy was evaluated clinically and cytomorphologically. The data was analyzed using Student’s test. Exfoliative cytology was undertaken with evaluation of epithelial cell morphology, mesenchymal cell origin, microbial flora characteristics and calculation of differentiation cells index.

Results: After 2 years of HAART the prevalence of oral candidiasis, oral herpes virus lesions, oral tumors (Kaposi’s sarcoma, Non-Hodgkin-Lymphoma), HIV-related periodontitis significantly decreased. However the prevalence of hyperplastic candidiasis, non-specific oral ulcers, oral papillomas, oral mucosal pigmentation increased and xerostomia worsened. There was a significant difference between the two arms in the time to achieve a clinical response in patients with ulcerative OML. 91,6% of them were symptom-free at the end of 10 days of treatment in the Corsodyl arm versus 66,6% of patients had complete improvement after 17,5±2,6 days in the bacteriophage arm. Bacteriophage therapy was less effective for generalized OML and was more suitable when foci of lesions were located in interdental, retromolar or periodontal areas. Corsodyl mouthrinses were better tolerated. Different levels of cytomorphological changes in the foci of lesions were found: abundant anaerobic flora (72,0%), candidiasis (13,1%), decrease of cells differentiation (53,8%), “left displacement” of epitheliocytogramm (14,7%) and plastic defects – ulcers, erosions, desquamation foci (94,9%).

Conclusion: HAART significantly changed the spectrum and prevalence of HIV oral manifestations. Both Corsodyl and Sexstophage can be effective in treating of ulcerative OML symptoms and in achieving clinical, microbiological and cytological response.