An acquired immune deficiency syndrome (AIDS) diagnosis is based on a positive human immunodeficiency virus (HIV) test and one of several opportunistic infections, or a CD4 cell count <200 cells/µL. Once an AIDS diagnosis has been made, the patient will always be categorized as having AIDS, even when no opportunistic infection is present or the CD4 cell count has rebounded to >200 cells/µL. However, a patient’s current level of immune suppression is more relevant to oral health care delivery.
HIV infection causes impairment of the immune system, which increases susceptibility to opportunistic infections including an array of different head and neck manifestations, such as salivary gland disease , lymphadenopathy , and oral manifestations, including candidiasis , herpes simplex virus infections , cytomegalovirus infections , oral hairy leukoplakia , human papilloma virus infections , Kaposi’s sarcoma , periodontal diseases , necrotizing stomatitis , Non-Hodgkin’s lymphoma , and major aphthous ulcerations . Certain opportunistic infections are AIDS-defining illnesses.
Laboratory values reflect the medical status of the HIV-infected patient.
CD4 cell count is a measure of immune competence.
Changes in HIV viral load is a measure of HIV disease progression and efficacy of anti-HIV medications.
A complete blood cell count (CBC) with differential will indicate if the patient has a low neutrophil count, which would indicate an increased susceptibility to bacterial infections; has a predisposition to certain bleeding tendencies; or suffers from some type of anemia.
Patients with a history of intravenous drug use are at an increased risk of contracting hepatitis B virus (HBV) and/or hepatitis C virus (HCV), developing infective endocarditis, and exhibiting drug-seeking behavior.
Special infection-control measures are necessary for patients with active pulmonary or laryngeal TB. Patients with inactive TB can be treated safely in a dental setting without added precautions.
Highly active antiretroviral therapy (HAART) is the mainstay of HIV therapy. Patients will take two or more antiretroviral medications, separately or in combination. Several antiretroviral medications have oral adverse sequelae, the most common oral side effect being salivary gland dysfunction and xerostomia that may place the patient at increased risk for dental caries and mucosal candidiasis .
Medications to treat and prevent opportunistic infections are given if the patient has an active infection or a low enough CD4 Cell Count that he or she is highly susceptible to a specific opportunistic infection.
Medications are also given to boost specific cell populations, such as red blood cells or neutrophils.
Oral Health Care Considerations
Classifications and Definitions
- Revised Surveillance Case Definition for HIV Infection — United States, 2014. MMWR. 2014;63(RR03:1-10)
- HIV testing, Center for Disease Control and Prevention (CDC). June 9, 2020.
- Terms, Definitions, and Calculations Used in CDC HIV Surveillance Publications. October 30, 2019.
- Screening for HIV infection. Screening. US Preventive Services Task Force recommendation statement. June 11, 2019.