AIDS and the oral cavity. The HIV-infection: virology, etiology, origin, immunology, precautions and clinical observations in 110 patients

Primary intraosseous AIDS-associated Kaposi's sarcoma. Report of two cases with initial jaw involvement

AIDS-associated Kaposi's sarcoma (KS), which in 80% of cases occurs in the oral cavity, usually presents with characteristic clinical features such as brown-bluish pigmented macules or tumorous lesions. In later stages the tumor, most probably originating from the vascular endothelium, may secondarily induce erosion of the underlying bone. The primary, intraosseous occurrence of KS has prompted the present 2 case reports. The tumor presented as extensive, diffuse osteolysis within the mandible without causing clinical symptoms. Although rare, intraosseous KS must be included in the differential diagnosis of isolated bone defects in HIV-infected patients.

Changing trends in oral cancer in the United States, 1935 to 1985: a Connecticut study

An extensive epidemiologic study was undertaken in an attempt to analyze patterns of oral cancer distribution and demography in Connecticut between 1935 and 1985. Sources of data for the investigation included both the Connecticut Tumor Registry (CTR) and the University of Connecticut Oral Pathology Biopsy Service. During the 51-year study period, 9,708 cases of primary oral cancer were reported to the CTR. Male age-adjusted incidence rates for overall oral cancer remained stable between 1935 and 1964 (14.5 to 14.8 per 100,000), with a gradual decline to 10.9 per 100,000 in the early 1980s. In contrast, age-adjusted rates for females advanced approximately threefold, from 1.4 per 100,000 in the 1930s to 4.1 per 100,000 in the early 1980s. There was a decrease in age-specific rates of oral cancer in males aged 70 and older; in contrast, age-specific incidence rates in females increased steadily over the same period. It was also found that female birth cohorts born in 1900 and later exhibited higher oral cancer incidence rates than those of previous cohorts. Between the 1960s and the present, male patients 30 to 39 years of age exhibited a nearly fourfold increase in oral cancer incidence; this was not observed among similarly aged females. Connecticut counties with highest oral cancer incidence rates in both sexes were the more densely populated Hartford and New Haven counties. In general, the picture of oral cancer, as revealed through analysis of cases accessioned by the University biopsy service between 1975 and 1986, exhibited similar trends to those disclosed by analysis of CTR data.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunoelectron microscopy shows an atypical pattern and a quantitative shift of collagens type I, III and VI in oral Kaposi's sarcoma of AIDS

The localization of collagen types I, III and VI in normal human alveolar and palatal mucosa and in oral Kaposi's sarcoma (KS) was studied by light microscopy and cryo-immunoelectron microscopy. Normal oral mucosa revealed two different types of organization. The upper connective tissue stroma contained a loose reticular network mainly composed of collagen types III and VI, while collagen type I immunostaining predominated in the deeper stroma. Ultrastructurally, in the KS tumour stroma, a loose pattern of individual thin collagen fibrils was noted. These often fanned out at their ends showing a filamentous substructure. The fibrils consisted predominantly of collagen type I similar to individual fibrils of normal oral mucosa. However, there was a marked loss of thick fibre bundles of collagen types I and III in KS compared with normal oral mucosa, whereas collagen type VI was markedly increased and found preferentially in clusters and strands around cross-striated fibrils that often spanned the distance between single collagen fibres. The abundance of collagen type VI in a pattern similar to early stages of wound healing suggests that the KS stroma resembles an early organizational stage of the interstitial and vascular extracellular matrix subject to a high rate of collagen turnover. This character of the KS stroma appears to result from a continuous auto-and paracrine stimulation of cell growth and collagen synthesis and provides an excellent model to study the structural arrangement of collagen type VI in relation to the fibrillar collagen types I and III.

Periodontal disease in HIV-infected patients in relation to lymphocyte subsets and specific micro-organisms

Visible plaque index (VPI), gingival bleeding index (GBI) and pocket depth (PD) were analyzed in relation to potential periodontal pathogenic microorganisms and peripheral numbers of T4+ and T8+ lymphocyte subsets in 10 patients with human immunodeficiency virus (HIV) infection, 10 patients with AIDS related complex (ARC) and 10 patients with acquired immune deficiency syndrome (AIDS). 10 healthy persons served as controls. Periodontal disease in patients with more advanced stages of HIV infection were related to the severity of the systemic disease, and to decreasing numbers of T4+ lymphocytes in peripheral blood, but not to VPI or the occurrence of periodontal pathogenic micro-organisms.

Oral manifestations of HIV infection and their management. II. Less common lesions

This second of two articles reviews the many uncommon and rare oral lesions that have arisen in persons infected with human immunodeficiency virus (HIV). The various drug-related oral disorders of HIV disease are also considered.

Oral manifestations of HIV infection and their management. I. More common lesions

Oral lesions are common at all stages of HIV infection. This first of two articles reviews the clinical features and pathogenesis of common oral manifestations of HIV disease (candidiasis, hairy leukoplakia, Kaposi's sarcoma, and HIV-related periodontal disease) and considers current treatment measures.

Oral hairy leukoplakia in HIV infection: a diagnostic pitfall

Twenty-nine human immunodeficiency virus (HIV)-infected patients with white, nonremovable lesions on the lateral border of the tongue, clinically suggestive of oral hairy leukoplakia (HL), were studied. In particular, the value of local antifungal therapy in establishing the diagnosis of HL was investigated. In 15 patients (52%) the lesions could be ultimately attributed to a candidal infection of the tongue. In 10 of the remaining 14 patients, a biopsy was obtained from lesions persisting after local antifungal treatment. In all biopsy specimens, the diagnosis of HL was confirmed by histopathologic examination and the demonstration of Epstein-Barr virus DNA by polymerase chain reaction, Southern blot hybridization, and DNA in situ hybridization. The present data confirm that the diagnosis of HL in HIV-infected patients cannot be reliably made on clinical criteria alone, but requires histopathologic confirmation including the demonstration of Epstein-Barr virus DNA, preferably by DNA in situ hybridization. However, with regard to the differential diagnosis of white, nonremovable lesions on the lateral border of the tongue in HIV-infected patients, the present study suggests that persistence of lesions after local antifungal therapy is highly suggestive of HL.

Treatment of refractory oral candidiasis with fluconazole. A case report

We describe a patient with the acquired immunodeficiency syndrome who had persistent oral esophageal pseudomembranous candidiasis clinically refractory to nystatin, clotrimazole, and ketoconazole. In vitro resistance to clotrimazole was demonstrated as well. The patient received temporary relief with intravenous amphotericin B therapy, but this was associated with serious adverse effects, including transfusion-requiring anemia, azotemia, and severe thrombophlebitis. Despite two courses of intravenous amphotericin B therapy, the patient's highly symptomatic, recurrent oral and esophageal candidiasis continued. The patient was then treated with fluconazole and obtained immediate relief without associated adverse effects.

Diagnosis of oral hairy leukoplakia by ultrastructural examination of exfoliative cytologic specimens

Lingual exfoliative cytologic specimens (scrapings) were obtained from 18 patients positive for human immunodeficiency virus with clinical oral hairy leukoplakia. Buccal mucosal scrapings were obtained from 12 of these patients. The specimens were processed for examination by transmission electron microscopy (TEM). Sixteen (89%) of the lingual specimens revealed infection of keratinocytes by herpes-type virus. There was no evidence of virus infection in the 12 buccal mucosal scrapings. Fungal hyphae were seen by TEM in 14 (78%) of the lingual scrapings and two (17%) of the buccal scrapings. One exfoliative specimen and two biopsy specimens were stained for Epstein-Barr virus DNA with a DNA probe. The demonstration of herpes-type virions by TEM in keratinocytes from a lesion clinically suspected to be hairy leukoplakia provides direct, objective diagnosis. Furthermore, use of exfoliative cytologic specimens provides a clinically simple, noninvasive technique.

Oral lesions in Mexican HIV-infected patients

One hundred and twenty-five HIV-infected patients, of whom 49 (39%) were at early stages of the infection (CDC-II & III) and 76 (61%) in CDC IV, were prospectively examined. In 100 (80%) one or more oral mucosal lesions were observed; candidiasis (51%) and hairy leukoplakia (43%) were the commonest. Erythematous candidiasis was more often seen (35%) than the pseudomembranous type (16%), and appeared with the higher values at early than later stages. The prevalence of hairy leukoplakia, oral hyperpigmentation and xerostomia were incremented in groups CDC-IV. Pseudomembranous candidiasis and exfoliative cheilitis increased significantly with severity of disease. Our study demonstrates that oral alterations associated to HIV are a frequent finding, both at early (76%) and late (83%) stages of the infection in Mexican patients.

Oral hairy leukoplakia

Oral hairy leukoplakia, usually observed on the lateral border of the tongue, may herald the development of symptomatic human immunodeficiency virus infection. This paper reviews the pertinent clinical features and differential diagnosis, histology, methods of establishing a definitive diagnosis, and management of the patient with this Epstein-Barr virus-associated lesion.

Negative staining EM for the detection of Epstein-Barr virus in oral hairy leukoplakia

The performance of two different EM techniques applied for the detection of Epstein-Barr Virus (EBV) in oral hairy leukoplakia (HL) was assessed, i.e. the conventional two-step method of negative staining (CNS) and negative staining after Airfuge enrichment (ANS). Scrape specimens from the lateral borders of tongue of 66 HIV-positive patients with or without HL, of 3 patients with infectious mononucleosis and of 10 HIV-negative patients were evaluated. While CNS resulted in virus detection only in 25% of clinically diagnosed HL cases, EBV was detected by ANS in 85% of clinically suspected cases of HL. Scrape specimens of individuals negative for HIV were negative in EM while 2 of 3 mononucleosis patients were positive without clinical evidence for HL. Due to this high sensitivity the method of negative staining after Airfuge enrichment appears to be useful in the diagnosis of HL. The finding of EBV in clinically normal oral mucosa in HIV-seropositive individuals is interesting and indicates that EBV expression may precede the clinical appearance of HL.

Prevalence of dental caries, gingivitis, and oral hygiene in hospitalized AIDS cases in Kinshasa, Zaire

The prevalence of dental caries and periodontal disease in African HIV-infected patients has not previously been assessed, in spite of the high prevalence of HIV-infection in some countries and the fact that atypical gingivitis may represent an early sign of HIV infection. In the present study 83 AIDS patients hospitalized in Kinshasa, Zaire, were assessed for dental caries, gingivitis and oral hygiene status. The prevalence of dental caries was lower among AIDS patients than among healthy controls previously examined in the same area. The prevalence of gingivitis was higher in AIDS than in controls in spite of good oral hygiene observed among AIDS patients.

Oral manifestations of AIDS in a heterosexual population in a Zaire hospital

Oral lesions associated with HIV infection as classified by the WHO Collaborative Centre for Oral manifestation of HIV were studied in 83 heterosexual AIDS patients in Kinshasa, Zaire. One or more lesions were fungal (94%), bacterial (33%) and viral (23%). Neoplasm was found in 12% of cases while lesions of unknown etiology in 14%. As location of those lesions, the palate, lips, tongue and the buccal mucosae mostly predominate as sites. The findings from this study were clinically similar to those reported in AIDS in other areas.

Cytomegalovirus associated oral ulcerations in HIV-infected patients

Oral ulcerations associated with disseminated cytomegalovirus (CMV) infection were observed in four patients with AIDS manifestations showing low CD4 counts. Virus cultures of urine and saliva samples were positive for CMV in all cases. The lesions were characterized by a punched-out appearance, non-indurated borders, low bleeding tendency and lack of inflammatory wall. Light microscopy revealed granulation tissue containing "owl's eye" like cells in all specimens. Presence of CMV was confirmed by immunohistochemistry and in situ hybridization. The ulcerations were infiltrated with T-lymphocytes of the helper, suppressor and cytotoxic subset, most were positive for HLA DR. Despite the local invasion with immunocytes and high serum titers of serum antibodies the patients experienced progressive CMV disease.

Prevalence of oral lesions among HIV-infected intravenous drug abusers and other risk groups

To study the prevalence of oral manifestations, we examined 217 patients infected with the human immunodeficiency virus (HIV). Most of our patients were intravenous drug abusers (IVDAs) (65%). Other risk categories were represented by IVDAs who were also male homosexuals or bisexuals (11%), male homosexuals and bisexuals (16%), sexual partners of HIV-infected patients (5%), and hemophilic persons and recipients of blood transfusions (3%). Forty-six patients were women and 171 were men, with a median age of 27 years (range, 11 to 65 years). At the time of first examination, 38% of patients had asymptomatic HIV infection, 36% had lymphadenopathy syndrome, 17% had AIDS-related complex, and 9% had AIDS. Oral manifestations were observed in 89 (41%) patients. Of these, 15 had asymptomatic infection, 23 had lymphadenopathy syndrome, 27 had AIDS-related complex, and 24 had AIDS. Increasing severity of disease was significantly associated with higher prevalence of oral lesions (p less than or equal to 0.0001). Candidiasis was the most common oral lesion, followed by hairy leukoplakia. Kaposi's sarcoma, melanotic macules, herpes labialis, condyloma acuminatum, perioral molluscum contagiosum, and bacterial glossitis due to Escherichia coli infection were found in a small number of patients. Results of culture for fungi, available for 203 patients, revealed that 51% of patients with positive Candida cultures had clinical evidence of candidiasis. Our study demonstrates that oral lesions are also important signs of HIV infection among IVDAs. Early diagnosis of these manifestations is becoming increasingly significant in the practice of dentistry.

Dental care for HIV-positive patients

This case-controlled study compared the types of routine dental services provided to an HIV-infected group with those provided to an HIV-negative cohort. No statistical differences in requesting dental treatment (routine or emergency) or in the types of dental treatment provided to the two groups were reported, except in the provision of prosthetic dentistry and the development of a comprehensive treatment plan.

Non-pigmented oral kaposi's sarcoma (AIDS). Report of two cases

In 90% of cases of AIDS-associated Kaposi's sarcoma (KS), the lesion is observed in the oral cavity. Oral KS usually reveals distinct clinical features characterized by a brown-bluish or otherwise pigmented appearance. The histological features are identical to classical KS. The occurrence of a non-pigmented oral KS in 2 male homosexual patients has prompted the present case reports. Clinicians should be aware that not all cases of AIDS-associated oral KS appear as brown or purplish tumors but may present without any discoloration.

Low prevalence of oral mucosal lesions in HIV-1 seropositive African women

In Nairobi (Kenya) 334 women prostitutes of whom 80.5% were HIV-1 positive, were examined for oral mucosal lesions; 15.6% of seropositive, and 4.6% of seronegative, women had oral mucosal lesions, predominantly oral candidiasis. In the seropositives, 8.6% had erythematous, 1.1% had hyperplastic candidiasis, and 0.4% had hairly leukoplakia as the only oral lesions; 0.4% had a combination of erythematous and hyperplastic candidiasis, and 1.5% had combinations of pseudomembranous and erythematous candidiasis in the presence of hairly leukoplakia. Of the 211 seropositive women for whom we knew the first date on which a positive serologic test was obtained, the likelihood of developing an oral mucosal lesion was found to be dependent on the duration of seropositivity. The low incidence of oral mucosal lesions in this population may be due to the relatively recent acquisition of HIV-1 infection.

Two different human papillomavirus (HPV) types associated with oral mucosal lesions in an HIV-seropositive man

Different types of Human papillomaviruses (HPV) are associated with a variety of oral lesions. So far, HPV types 1, 2, 4, 6, 7, 11, 13, 16, 18, 32 and 57 have been identified in oral lesions. Immunosuppression predisposes oral mucosa to clinical manifestation of different virus infections including HPV. We describe here a 30-year-old HIV-positive and immunosuppressed man, who had suffered from oral lesions for a few months. On clinical examination, a nodular elevation was detected on the lower lip, and white keratotic areas were present on buccal mucosa bilaterally. A biopsy from the lip revealed the presence of acanthosis with a prominent granular cell layer as well as hyperparakeratosis. A biopsy from the buccal lesion showed a comparatively much flatter lesion with merely basal cell hyperplasia associated with hyperparakeratosis. Koilocytosis was a characteristic feature in both biopsies. In Southern blot hybridization, both lesions hybridized with a probe cocktail comprising HPV 6, 11, 16, 18, 31 and 33 DNA under low stringency. Under high stringency, the lip lesion proved to contain HPV 7 DNA, which also confirmed by in situ hybridization. The buccal lesion was weakly positive by Southern blot with HPV 11 and 13 probes hybridized under stringent conditions, but the restriction patterns with Pst I and Bam HI did not fit with those of any of the 57 HPV types known so far. In situ hybridizations with HPV 11 and HPV 13 probes were negative. Cloning of this 'new' HPV type is currently under way.

Regression of oral Kaposi's sarcoma in a case of AIDS on zidovudine (AZT)

A case with oral Kaposi's sarcoma (KS) is reported that regressed during therapy with Zidovudine (AZT) which was started 5 months after the first dermal and oral tumours were noted. After 6 months of treatment the absolute number of T-helper cells had increased from 54/microliters to 232/microliters and the ratio of T-helper to T-suppressor cells from 0.15 to 0.3. During the same time the lesions of KS on the gingiva, uvula and the body as well as the face disappeared. The lesion of KS on the hard palate regressed.

Classification of oral lesions associated with HIV infection

This article proposes a classification for oral lesions associated with HIV infection. The lesions can be classified into those with fungal, bacterial, or viral origin whereas other subgroups include neoplasms, neurologic disturbances, and lesions of unknown cause. This proposal is neither final nor exhaustive and is forwarded as a basis for epidemiologic surveys.

Oral hyperpigmentation in HIV-infected patients

Six cases of oral hyperpigmentation in HIV-infected patients are reported. While in two patients the lesions could be related to systemic clofazimine or ketoconazole therapy, in the other patients the cause remained unknown. Clinically, the pigmentations were characterized by a sudden onset and the appearance of well-defined, brown-black macules in the buccal mucosa, the gingiva, the hard palate, or the lateral borders of the tongue. In one patient, longitudinal hyperpigmented striae were observed on all fingernails and toenails. Histologically, hyperpigmentations associated with systemic medication revealed accumulation of melanin in phagocytes and extracellularly within the connective tissue. In those lesions with unknown cause, melanin was restricted to keratinocytes of the basal cell layer or to extracellular foci in the lamina propria. The clinical and histologic findings, as well as differential diagnosis, are discussed.

Oral manifestations of HIV infection in 75 Dutch patients

Seventy-five consecutive HIV-infected patients, including 33 AIDS cases were examined. One or more oral mucosal lesions were observed in 57 (76%); candidiasis was the most common finding (52%). Others included hairy leukoplakia (16%), periodontal disease (16%) and Kaposi's sarcoma (4%). Diversity of study design and methods allowed no reliable comparison with other reports.

Oral hairy leukoplakia is not a specific sign of HIV-infection but related to immunosuppression in general

Oral hairy leukoplakia (HL) has been regarded as an early sign of HIV infection, and its clinical importance related to the poor outcome of the patients has been emphasized. Initially, HL was observed exclusively among male homosexuals, but subsequently demonstrated in all risk groups of HIV infection. The patient described in this article suggests that oral HL is not specific for HIV infection per se, but may be associated with immunosuppression also due to other causes. We describe an HIV-seronegative, heterosexual man suffering from an acute myeloblastic leukemia, who developed clinically and histologically typical HL while on cytostatics. Biopsy showed areas with characteristic ballooning cells, and hyphae of yeasts were demonstrated with PAS-stain. Using the in situ hybridization technique, Epstein-Barr virus (EBV) DNA with high copy numbers was disclosed in the superficial and intermediate cells, whereas human papillomavirus (HPV) DNA (types 6, 11, 16, 18) was not present.

Ultrastructural findings in clinically uninvolved oral mucosa of patients with HIV infection

Twelve biopsies of clinically normal oral mucosa taken from HIV seropositive patients have been investigated by means of light- and electron microscopy. Vascular abnormalities were found in all biopsies, regardless of the clinical stage of the HIV infection. In particular slit-like vascular channels, sparseness of intercellular junctions and swollen, protruded endothelial cells with an increased quantity of Weibel-Palade bodies were noticed. These findings were similar to those described in lesions of early stage Kaposi's sarcoma.

Orofacial manifestations of a group of British patients infected with HIV-1

The orofacial manifestations of 44 HIV-infected individuals from the South West of England are reported. Oral candidiasis, periodontal disease and cervical lymphadenopathy were the most commonly observed disorders although hairy leukoplakia was also present in 15% of patients. The orofacial features of this group of British patients are similar to those of HIV-infected individuals from other parts of Europe, North America and Scandinavia.

Antibody testing and counseling of dental patients at risk for human immunodeficiency virus (HIV) infection and associated clinical findings

Two hundred six dental patients were tested between 1985 and 1987 for antibodies to human immunodeficiency virus (HIV) when a review of their medical histories revealed a high risk for infection. Serologic results are correlated with soft tissue and osseous findings recorded during routine head and neck and radiographic examination. Counseling recommendations for use in association with testing are outlined. A more active role for the dentist as a preventive agent is advocated to combat the spread of acquired immunodeficiency syndrome (AIDS).

Impairment of cranio-facial nerves due to AIDS. Report of 2 cases

2 cases of disorders of craniofacial nerves resulting from progressive multifocal leucoencephalopathy are described. Clinical symptoms occurred as facial paralysis, hypaesthesia, hemianopsia and deafness. In both patients, the impairment of the central nervous system (CNS) preceded indicative AIDS symptoms. Both patients died about 3 months after the first CNS symptoms had been diagnosed. Clinical and neurohistopathological findings as well as differential diagnoses are discussed.

The prevalence of AIDS-associated oral lesions in a cohort of patients with hemophilia

Oral and perioral lesions have been widely reported in homosexual males and intravenous drug abusers who are seropositive for the human immunodeficiency virus (HIV) or have acquired immunodeficiency syndrome (AIDS). Several case reports have also noted some AIDS-associated lesions among persons with hemophilia, but the prevalence of these lesions in hemophilia populations is not known. This study investigated the prevalence of oral and perioral lesions in a cohort of patients receiving care at a hemophilia treatment center. In a sample of 32 patients with a factor VIII deficiency and 5 patients with a factor IX deficiency who underwent oral examinations, more than 80% were HIV seropositive. Cervical lymphadenopathy was present in more than half of the patients who were HIV seropositive but was absent in those who were HIV seronegative. Intraoral AIDS-associated lesions were present only in patients for whom a diagnosis of AIDS had been made, indicating that oral lesions among persons with hemophilia who are HIV seropositive may be less prevalent than among homosexual males or intravenous drug abusers who are HIV seropositive.

Immunohistochemical detection of HIV structural proteins and distribution of T-lymphocytes and Langerhans cells in the oral mucosa of HIV infected patients

Seventeen biopsies taken from oral mucosa of HIV infected patients were analysed for the distribution of CD4+/CD8+ T-lymphocytes and Langerhans cells. The results were evaluated statistically. An increase in the absolute number of CD4+ and CD8+ cells in HIV infected patients without clinical symptoms, ARC or AIDS was seen in the connective tissue stroma when compared with normal oral mucosa from sero-negative patients. However, the ratio between CD4+/CD8+ cells was decreased due to the disproportionate increase of CD8+ cells. These findings did not show statistical correlation with the clinical status of the infection. In contrast to the increase in absolute number of CD4+/CD8+ cells the number of Langerhans cells was unchanged when compared with the control group. Using four different monoclonal antibodies against virus structural proteins (2 X anti p24, gp41, gp120) two of 26 patients showed labelled cells in consecutive sections in the same connective tissue areas. It was assumed that latently infected mononuclear cells invaded the oral mucosa together with uninfected cells of the cellular immune system.

Ultrastructural and immunohistochemical findings in oral hairy leukoplakia

Three cases of HL from the lateral border of the tongue of male homosexual AIDS patients were investigated by thin section electron microscopy. Keratinocytes contained condensed chromatin in their pyknotic nuclei and a few organelles in the oedematous cytoplasm. Chromatin was in close association to the nuclear membrane and showed a punched-out appearance. Particles typical of the herpes virus group were abundant in the upper two thirds of the epithelium in all three cases. Virus particles were seen frequently in the nuclei of the ballooned keratinocytes, but rarely in cells containing Candida albicans. Viral nucleocapsids were observed budding at the inner nuclear membrane, thereby acquiring the prospective viral envelope. Complete, enveloped virions were found in the endoplasmic reticulum and in the extracellular space. These virions were identified immunohistochemically as Epstein-Barr virus (EBV) using two monoclonal antibodies directed against EBV capsid and membrane antigen, respectively. Candida albicans was observed in the stratum corneum and in the upper layer of the stratum spinosum. Special cytoplasmic tubular structures arranged in parallel bundles were found in koilocytotic cells in addition to characteristic membrane structures composed of undulating convoluted membranes. Epithelial basement membranes were always intact.

In situ hybridization to detect Epstein-Barr virus DNA in oral tissues of HIV-infected patients

Thirty biopsies of oral mucosal lesions and normal oral mucosa were obtained from 26 HIV-seropositive individuals and studied for virus infections with Epstein-Barr virus-specific DNA probes (EBV). In situ DNA hybridization was carried out on frozen and formalin-fixed, paraffin-embedded tissues. Specifically bound biotinylated virus probes were detected with the streptavidin-gold-silver technique and visualized by standard and interference reflection microscopy. In 9/30 biopsies, EBV DNA was clearly demonstrated in the upper two thirds of oral epithelia. This finding corresponded to peculiar cytopathic effects including ground glass nuclei, basophilic nuclear inclusions, and ballooning of the cytoplasm, which were concentrated in the upper two or three layers of the stratum spinosum. Cytopathic effects together with the demonstration of EBV DNA were demonstrated in seven cases of tongue mucosa, and two cases derived from the gingiva. When comparing clinical and pathological findings with DNA detection rates, we saw 5/9 hairy leukoplakias associated with EBV infections. Four positive cases (two samples from the tongue, two gingival specimens) had not been regarded as hairy leukoplakia clinically. EBV infection of the oral epithelium occurred in male homosexuals (7 cases) and in male/female intravenous drug abusers (2 cases). Among the nine EBV-positive cases, 2 patients were asymptomatic, 4 patients were grouped into the ARC-, and 3 individuals into the AIDS-category. We conclude that HIV-seropositive patients are particularly prone to develop productive EBV infections in oral epithelia. This infection most frequently appears at the lateral border of the tongue, but may also occur at other sites of the oral cavity, and may already exist in a preclinical stage prior to the development of oral white lesions (hairy leukoplakia).

The extracellular matrix in oral Kaposi sarcoma (AIDS): the immunohistochemical distribution of collagens type IV, V, VI, of procollagens type I and III, of laminin and of undulin

Twelve oral AIDS-associated Kaposi sarcomas (KS) were studied for the distribution of extracellular matrix components using indirect immunofluorescence. Staining for basement membrane (BM) components revealed two distinct patterns of distribution: a delicate and partly fragmented lining of BMs around sinusoid-like vascular spaces or an occasional diffuse interstitial fluorescence in the tumour stroma; or an irregular broad rim of fluorescence in walls of larger blood vessels. These findings support a vascular cell origin of the endothelial- and spindle cell component in KS. The tumour stroma was almost completely negative for collagen type V and undulin, whereas an intensive fluorescence was noted for procollagens type I, III and collagen type VI. In areas adjacent to KS a loss of procollagens type I and III, collagens type V, VI and undulin was noted. An intimal sheath of collagen type V was usually absent from blood vessels of the tumour or the peritumourous connective tissue. Immunohistochemical findings indicate that the preexisting interstitial connective tissue matrix is destroyed during tumour invasion and that subsequently procollagens type I, III and collagen type VI are synthesized de novo by cells of the tumour stroma.