The Impact of Social and Cultural Factors on Oral Manifestations of HIV Infection Management in the UK

Introduction: Drug resistance, compliance and adverse effects of HAART, epidemic evolution, as well associal and behavioural factors continue to impact on presentation and management of HIV infection in the UK.

Cases: We detail three HIV-infected individuals presenting diverse oro-facial/systemic manifestations, their management affected by social, behavioural and cultural factors.

A: 48 year old Caucasian male with high risk sexual behaviour gave a 2 month history of oral discomfort and dysphagia failing to respond to fluconazole. Examination revealed ulceration of the tongue, lips and palate consistent with lues maligna. 17 days of IM penicillin led to resolution. Contact tracing was impractical.

B: 17 year old Afro-Caribbean female with perinatally-acquired, multi-drug resistant HIV infection, with severe necrotising periodontitis progressing to necrotising stomatititis. This responded well to frequent local debridement and systemic antibiotics. She subsequently developed severe HIV-related oral ulceration responding to thalidomide. Non compliance and lack of insight despite a life time of infection impacted on management and eventually led to her death.

C: 18 year old Afro-Caribbean female with severe HIV-related immune thrombocytopenia, needle-phobia and non-compliance with HAART following the loss of her main carer, with extensive caries and necrotizing ulcerative gingivitis. She became the sole carer for 2 younger relatives and was unable to manage her own health need. Stability was obtained with local therapy and systemic antibiotics. Corticosteroids partially corrected the thrombocytopenia before multiple extractions.

Conclusion: HAART therapy failure, a return to high risk sexual behaviour, social and cultural factors impact on an increased frequency and nature of presentation, diagnosis and successful management of HIV-infected individuals in London.