Management of oral lesions in HIV-positive patients

Lorena Baccaglini, Jane C. Atkinson, Lauren L. Patton, Michael Glick, Giuseppe Ficarra, Douglas E. Peterson

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

HIV/AIDS is currently the leading cause of death in Africa and the fourth leading cause of death worldwide. This systematic review of the literature was conducted to evaluate the evidence for treatment of the most common oral lesions associated with HIV: oral candidiasis with or without oropharyngeal involvement (OPC), oral hairy leukoplakia (OHL), recurrent aphthous-like ulcerations (RAU), oral Kaposi's sarcoma (OKS), orolabial herpes simplex infection (HSV), oral herpes zoster infection (VZV), intraoral or perioral warts (HPV), and HIV-associated periodontal diseases. Treatment of HIV-associated salivary gland disease is addressed in a different section of this World Workshop. We found the largest body of evidence for treatment of OPC in HIV patients. Future trials will be needed to test drugs currently in development for treatment of Candida strains that are resistant to existing therapies. There were no double blind, placebo-controlled randomized clinical trials (RCT) for topical treatment of OHL, and only one RCT for systemic treatment of the lesion with desciclovir. Systemic thalidomide was the only drug tested in RCT for treatment or prevention of RAU. Only 1 double-blind RCT comparing vinblastine and sodium tetradecyl sulfate was identified for localized treatment of OKS. Three drugs (famciclovir, acyclovir, and valaciclovir) were shown to be effective in randomized, double-blind trials for treatment or suppression of mucocutaneous HSV lesions in HIV patients. In all 3 trials, the effects of these medications on orolabial HSV lesions were not reported separately. There were no double-blind, placebo-controlled RCT testing topical treatments for orolabial HSV lesions in HIV patients. No trials testing treatments of oral VZV were identified. There were no double-blind, placebo-controlled RCT for treatment of HIV-associated intraoral or perioral warts or periodontal diseases. In conclusion, there is a need for well-designed RCTs to assess the safety and efficacy of topical and systemic treatments of most oral mucosal and perioral lesions in HIV patients. There is also a need to develop newer drugs for treatment of resistant fungal and viral microorganisms. Finally, standardized outcome measures should be developed for future clinical trials to allow comparisons of studies using different populations.

Original languageEnglish (US)
Pages (from-to)S50.e1-S50.e23
JournalOral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology
Volume103
Issue numberSUPPL.
DOIs
StatePublished - Mar 2007

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HIV
Randomized Controlled Trials
Therapeutics
Hairy Leukoplakia
Warts
valacyclovir
Kaposi's Sarcoma
Placebos
Periodontal Diseases
Pharmaceutical Preparations
Cause of Death
Sodium Tetradecyl Sulfate
Salivary Gland Diseases
Oral Candidiasis
Herpes Simplex
Thalidomide
Acyclovir
Vinblastine
Herpes Zoster
Infection

ASJC Scopus subject areas

  • Surgery
  • Oral Surgery
  • Otorhinolaryngology
  • Dentistry(all)

Cite this

Management of oral lesions in HIV-positive patients. / Baccaglini, Lorena; Atkinson, Jane C.; Patton, Lauren L.; Glick, Michael; Ficarra, Giuseppe; Peterson, Douglas E.

In: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, Vol. 103, No. SUPPL., 03.2007, p. S50.e1-S50.e23.

Research output: Contribution to journalArticle

Baccaglini, Lorena ; Atkinson, Jane C. ; Patton, Lauren L. ; Glick, Michael ; Ficarra, Giuseppe ; Peterson, Douglas E. / Management of oral lesions in HIV-positive patients. In: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology. 2007 ; Vol. 103, No. SUPPL. pp. S50.e1-S50.e23.
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