Etiology

• RNA retrovirus – Human Immunodeficiency Virus

Pathology

• HIV – specific affinity for – CD4+ T helper cells – Therefore damage cell mediated immune system
• Enters host – replicates using host DNA – stay latent – cell fusion/cell death
• Notes under Virology

Modes of spread

• Vertical transmission and breast feeding
• Sexual contact
• Parental exposure:
  • Organ transplant
  • Blood transfusion
  • Contaminated needles
  • Artificial insemination

Clinical

1. Systemic signs and symptoms

• Chronic fever
• Weight loss
• Diarrhea
• TB
• Persistent generalized lymphadenopathy
• Encephalopathy (AIDs dementia)
• Other STIs

2. Oral infections

• Fungal:
  • Candidiasis
  • Histoplasmosis
  • Cryptococcus neoformans
  • Penicilliosis

• Viral:
  • Herpes: HSV, VZV, EBV, CMV
  • EBV – Hairy leukoplakia

• Bacterial:
  • PDL disease – Linear gingival erythema, NUG, NUP, Necrotizing stomatitis
  • NOMA
  • TB – Chronic indurated non healing ulcer, TB osteomyelitis
  • Necrotizing fasciitis

• Autoimmune:
  • Recurrent aphthous ulcer
  • Salivary gland disease
  • Idiopathic thrombocytopenic purpura (ITP) – Gingival bleeding, petechia, hamartomas on mucosa, palate and tongue
  • Diffuse infiltrative lymphocytosis syndrome (DILS)

• Protozoa: Leishmania

3. Oral neoplasms

• Most common: Kaposi sarcoma
• Less common:
  • Non Hodgkin’s lymphoma
  • Squamous cell carcinoma

4. Other manifestations

• Cervical lymphadenopathy
• Neurologic:
  • Trigeminal neuropathy
  • Facial palsy
• Aphthous ulcer
• Xerostomia
• Hyperpigmentation
• Exfoliative chelitis
• Lichen planus
• Hairy leukoplakia
• Thrombocytopenia
• Opportunistic infections

Diagnosis

• ELISA
• PCR
• CD4 counts
• CD4 : CD8
• Indirect immunofluorescence – HIV specific IgM

Management

• ARVs eg. Zidovudine, Ritonavir

Clinical features of pediatric AIDs

Age of onset: Neonate to late infancy

Infections:

• Fungi – C. albicans
• Mycobacteria – M. TB, M. bovis, atypical
• Bacteria – S. pneumonia, S. aureus, Gram -ve’s
• Virus – HSV, EBV, VZV, CMV, adenovirus
• Protozoa – P. carinii (Update: Now considered a fungus by the name Pneumocystis jirovecii)

Malignancy:

• Lymphoma
• Kaposi sarcoma – rare

Nutrition:

• Diarrhea
• Failure to thrive

Systemic:

• Fever
• Lymphadenopathy
• Hepatosplenomegaly

Parotid: Diffuse, non suppurative enlargement

CNS: Developmental delays

AIDS dysmorphic syndrome: Variable teratogenicity