Laser palliation of oral manifestations of human immunodeficiency virus infection

Laser palliation of oral manifestations of human immunodeficiency virus infection
CASE REPORT
ROBERT A. CONVISSAR, D.D.S.

ABSTRACT
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ABSTRACT
ORAL MANIFESTATIONS AND THEIR...
CASE REPORTS
CONCLUSIONS
REFERENCES

Background. The author describes the use of lasers to palliate the oral manifestations of the human immunodeficiency virus, or HIV, infection. He discusses the advantages to both patients and dentists, but he does not address the use of lasers as a modality to treat or cure HIV infection.
Case Description. Many oral manifestations of HIV infection can be used as markers for degree of immunosuppression. These manifestations may be treated with antibiotics, analgesics and antineoplastics, which may interact and interfere with antiviral agents used to treat the disease and possibly may exacerbate it. The author describes laser palliation of the oral manifestations of three HIV-positive patients.

Clinical Implications. Dentists will see more patients living longer with HIV as the disease becomes more treatable. Lasers have been shown to be effective instruments in palliation of oral manifestations of HIV infection.

Because of advances in treatment of human immunodeficiency virus, or HIV, infection, more patients who are HIV-positive are living longer while being chronically infected with HIV. The Centers for Disease Control and Prevention, or CDC, has reported a significant decrease in the incidence of acquired immunodeficiency syndrome, or AIDS, deaths along with an increase in the number of people who are infected with AIDS.1 The CDC reported a 42 percent decrease in the number of AIDS deaths between 1996 and 1997, and an additional 20 percent decrease in AIDS deaths between 1997 and 1998. The CDC further reported a 10 percent increase in the number of patients living with AIDS between 1997 and 1998. Both of these trends continued into 1999 and 2000, the latest years for which statistics were available. The table shows the CDC statistics of the estimated number of people living with AIDS in the United States and the estimated number of AIDS deaths in the same period for the five-year period of 1996 through 2000.

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TABLE ESTIMATED NUMBER OF ACQUIRED IMMUNODEFICIENCY SYNDROME CASES AND DEATHS, BY YEAR.*

More patients are living longer while being chronically infected with human immunodeficiency virus.

The CDC attributes the increase in the number of people living with AIDS to the effects of new treatments. The advent of protease inhibitors and other drugs over the past few years has made a significant impact on the rate of AIDS deaths. The CDCÌs statistics have strong implications for dentists. Dental practitioners will be seeing more chronically infected patients and will be asked to perform more dental treatment on these patients than in the past.

Dentists should become familiar with the oral manifestations of HIV infection and how to treat them. They include, but are not limited to:

Ò KaposiÌs sarcoma, or KS;

Ò aphthouslike ulcer;

Ò human papillomavirus, or HPV, infection;

Ò linear gingival erythema, or LGE (formerly HIV-associated gingivitis);

Ò necrotizing ulcerative periodontitis, or NUP (formerly HIV-associated periodontitis);

Ò hairy leukoplakia;

Ò candidiasis.

Oral manifestations of HIV infection may be the first signs of the disease, and the presence or progression of some lesions, such as candidiasis, NUP and hairy leukoplakia, may be used as important markers for disease staging and progression.2 Laskaris and colleagues3 documented one or more oral lesions in more than 90 percent of their HIV-positive population. Mascarenhas and Smith4 noted studies that document oral manifestation in 70 percent of HIV-positive patients. Glick and colleagues5 examined 454 HIV-positive patients and used various oral manifestations to predict HIV helper, or CD4, cell count. Their results showed that the presence of major aphthae has a predictive value of 100 percent for a CD4 count of less than 200 cells per cubic millimeter; necrotizing ulcerative gingivitis, or NUG, has a predictive value of 95.1 percent for a CD4 count of less than 200 cells/mm3; and KS has a predictive value of 93.6 percent for CD4 of less than 200 cells/mm3. They concluded that oral manifestations are highly predictive markers of immune system depression and disease progression. The AIDS Institute2 stated that treatment of the oral manifestations of HIV infection can improve a patientÌs attitude, quality of life and general health. It also stated that poor oral health can complicate the management of medical conditions and create or exacerbate nutritional and other problems.

Physicians may call on dentists to become more active in the total health care of immunocompromised patients.

Physicians may call on dentists to become more active in the total health care of immunocompromised patients. Ethically and legally, dentists are obligated to treat patients who have HIV as long as the necessary treatment is within the parameters of care delivered to seronegative patients in their practices.6,7

There are several books and articles that document and describe the oral manifestations of HIV infection and provide thorough descriptions.4,8Ò11 In this article, I briefly describe some of the more common oral manifestations of HIV infection and their treatment with lasers. I also describe the use of lasers to palliate one of the painful oral manifestations of HIV infection. I do not, however, address the use of lasers to cure or treat HIV infection.