HIV/AIDS

What is HIV?

• H – Human – can only infect human beings.

• I – Immunodeficiency – HIV weakens your immune system by destroying important cells that fight disease and infection.

• V – Virus – A virus can only reproduce itself by taking over a cell in the body of its host.

What is AIDS?

• A – Acquired –You acquire AIDS after birth.• I – Immuno – Your body's immune system includes all

the organs and cells that work to fight off infection or disease.• D – Deficiency – You get AIDS when your immune

system is "deficient," or isn't working the way it should.• S – Syndrome – A syndrome is a collection of

symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.

Occurrence

Treatment

Medications• Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs): These drugs

work to block a very important step in HIV’s reproduction process. They act as faulty building blocks in production of viral DNA production. This blocks HIV’s ability to use a special type of enzyme (reverse transcriptase) to correctly build new genetic material (DNA) that the virus needs to make copies of itself.• tenofovir, emtricitabine, and abacavir

• Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): They also block the enzyme, reverse transcriptase, and prevent HIV from making copies of its own DNA. But unlike the NRTIs (which work on the genetic material), NNRTIs act directly on the enzyme itself to prevent it from functioning correctly.• efavirenz, nevirapine, or etravirine

• Protease Inhibitors (PIs): When HIV replicates inside your cells, it creates long strands of its own genetic material. These long strands have to be cut into shorter strands in order for HIV to create more copies of itself. The enzyme that acts to cut up these long strands is called protease. Protease inhibitors block this enzyme and prevent those long strands of genetic material from being cut up into functional pieces.• atazanavir, ritonavir, or darunavir

• Entry/Fusion Inhibitors: These medications work to block the virus from ever entering your cells in the first place. HIV needs a way to attach and bond to your CD4 cells, and it does that through special structures on cells called receptor sites. Receptor sites are found on both HIV and CD4 cells. Fusion inhibitors can target those sites on either HIV or CD4 cells and prevent HIV from "docking" into your healthy cells.• enfuvirtide and maraviroc

• Integrase Inhibitors: HIV uses your cells’ genetic material to make its own DNA. Once that happens, the virus has to integrate its genetic material into the genetic material of your cells. This is accomplished by an enzyme called integrase. Integrase inhibitors block this enzyme and prevent the virus from adding its DNA into the DNA in your CD4 cells. Preventing this process prevents the virus from replicating and making new viruses.• raltegravir

• Fixed-dose combinations: These are not a separate class of HIV medications but combinations of the above classes and a great advancement in HIV medicine. These antiretrovirals are combined into one single pill with specific fixed doses of these medicines.

Oral Manifestations

• Head and neck manifestations• Oral symptoms/findings• Referrals• Early intervention• Extraoral Examination• Intraoral Examination

Extraoral Examination

A thorough exam must be taken at each appointment.

• Lymphadenopathy• palpation for enlarged lymph nodes

• Skin Lesions (Table 2-6,pg. 47)• Kaposi’s sarcoma• Purpura• Herpetic lesions

Intraoral Examination

Table 2-6, pg.47• Fungal Infections • Oral candidiasis

• Viral Infections• herpes simplex• hairy leukoplakia• oral chickenpox lesions • verruca vulgaris• condyloma acuminatum• cytomegalovirus ulcer

• Bacterial Infections: gingival an periodontal infections

• may or may not be unusual• Periodontal infection symptoms my be more severe and rapid.

• Linear Gingival Erythema:• 2-3mm red band along gingival margin• Spontaneous bleeding• Frequent maintenance plan

• NUG:• Increased incidence• Ulceration and destruction of interdental papillae

• NUP:• Severe attachment and tissue destruction

• Periodontal Infection:• Range of severity• Depends on immune status

• Oral finding in children• Persistent oral candidiasis• Parotiditis• Herpetic gingivostomatitis• Aphthous ulcers• Hairy leukoplakia• Linear gingival erythema• NUG/NUP

Medications-ORAL THREAT• Zidovudine (AZT) or retrovir• dental caries and dental erosion

• Mycostatin• oral candidiasis• may have sucrose and applied several times a day

• Xerostomia• medications • salivary gland diseases

• Fluoride applications• Daily• professional

Modifications for Dental Hygiene Treatment• Treatment modifications may or may not be necessary for an

HIV/AIDS patient• Modifications are based not on the disease itself, but on the

manifestations of the disease• Premed is usually not needed , but may be prescribed if blood

cell or neutrophil count is too low.• If severe problems with platelet counts exist, a patient could

benefit from seeing a dentist who specializes in medically compromised patients

• An antibiotic mouth rinse may also be prescribed before or after treatment

Patient Modifications• As with any patient, standard infection control procedures

should be followed with HIV/AIDS patients• Ultrasonic use is not contraindicated and may actually be a

better choice because of the lowered chance of instruments sticks for clinicians

• Patient positioning and appointment length are determined by the manifestations of HIV/AIDS rather than the disease itself

• Patients who have well-controlled HIV are less likely to require modifications

Recall Schedules• Patients with HIV/AIDS

should be seen on a frequent recall schedule• They are at risk for

numerous oral conditions • Meticulous home and

professional care are vital to maintain health

Question 1

True or False:

Premedication is necessary for all HIV/AIDS patients.

Question 2

• HIV can be transmitted through• A Tears• B Saliva• C Breast milk• D Sweat

Question 3

• This intraoral lesion is strongly associated with the HIV/AIDS infection• A candidiasis• B Kaposi’s sarcoma• C hairy leukoplakia• D All of the above