Oral Manifestations Of Human Immunodeficiency Virus Infection

Laryngeal cancer in acquired immunodeficiency syndrome

With improved survival, more AIDS patients, especially heavy smokers and alcohol abusers, may be confronted with laryngeal squamous cell carcinoma. Since curative treatment may require aggressive combined therapy, these patients, often suffering from immunosupression and poor general condition, present unique therapeutic challenges. The objective of the study was to describe treatment dilemmas. This case report presents a detailed description of an AIDS patient with carcinoma of the larynx. A patient with T3N0M0 laryngeal carcinoma and AIDS underwent tracheotomy and biopsy, followed by severe neck and pulmonary infection. After convalescence, radiotherapy was administered, with no evidence of a disease during a 3.5-year follow-up. During his remaining life, the patient developed severe psychoaffective disorder, his immune state deteriorated until he demised from sepsis. In conclusion, patients with HIV infection, especially having a history of tobacco or alcohol abuse, should be carefully examined for head and neck carcinoma that is likely to be more aggressive. Following surgery, AIDS patients may have worse wound healing and a greater tendency to contract infections. Radiotherapy and especially chemotherapy may cause life-threatening complications. Although early detection may increase survival, curative treatment should involve many disciplines and extra caution.

Oral candidosis and oral hairy leukoplakia as predictors of HAART failure in Brazilian HIV-infected patients

INTRODUCTION

Oral candidosis (OC) and hairy leukoplakia (OHL) are important markers of Human Immunodeficiency Virus (HIV) infection immune status.

OBJECTIVES

to evaluate if OC and/or OHL should be considered clinical predictors of immune and virologic failure on HIV-infected Brazilian adults undergoing Highly Active Antiretroviral Therapy (HAART).

METHODS

124 HIV-infected patients who used HAART for a minimum of six months were prospectively evaluated. All of them under-took oral examination and serum CD4+ count and viral load (VL), being divided in two groups, P and A, respectively according to the presence or absence of OC and/or OHL. During a six month period, patients belonging to group A were followed. They were re-examined for new oral lesions. New blood samples were collected and they were subdivided into groups P6 and A6. CD4+ count and VL were compared between groups at baseline and after the six months period. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and relative risk (RR) were obtained in order to assess the accuracy of using OC and OHL as predictors of immune and virologic failure, at baseline and after a six month period.

RESULTS

At baseline and after six months, patients with OC and OHL have mean CD4+ count lower and mean VL higher than patients of group A and A6 (p < 0.001). OC had high PPV for immune failure and a moderated PPV for virologic failure. OHL had low PPVs for both measures.

DISCUSSION AND CONCLUSIONS

OC and OHL still indicate low serum CD4+ count and high VL, but OC seems to be a better predictor of immune and virologic failure in patients undergoing HAART than OHL.

HIV manifestations in otolaryngology

PURPOSE

AIDS is a fatal illness, which breaks down the body's immunity and leaves the victim vulnerable to life-threatening opportunistic infections, neurological disorders, or unusual malignancies. About 80% of patients with HIV infections present with otolaryngological symptoms. Often, the otolaryngologist is the primary physician who diagnoses the HIV infection. He should be aware and vigilant for its symptoms and unusual presentations. The aim of our study was to determine the incidence of otolaryngological manifestations, the clinical presentations, relevant diagnostic tools, management, and survival rates.

MATERIALS AND METHODS

We studied 968 patients who were diagnosed to have HIV infection at Kasturba Medical College, Mangalore, India, from January 1996 to December 2004. The incidence of otolaryngological manifestations was noted. Patients with opportunistic infections were treated by specific and symptomatic measures. Of 968 patients studied, 419 were followed up for a 5-year period.

RESULTS

In our study, otolaryngological findings were noted in 79% of individuals. Oropharyngeal findings, which were the commonest, were seen in 59%, followed by cervical lymphadenopathy in 42% of patients. Oral candidiasis was the commonest oropharyngeal finding, seen in 39% of patients. Among nasal complaints, rhinosinusitis was the commonest, found in 17% of patients. Otological manifestations were seen in 20%, of which chronic suppurative otitis media was the commonest, seen in 13% of patients. Routine investigations were found to suffice for diagnosis. Of 419 patients who were followed up, the 5-year survival rate was 73%.

CONCLUSION

With the increase in the number of AIDS cases, it is important for otolaryngologists to be aware of otolaryngological manifestations. Early diagnosis and timely intervention along with appropriate antiretroviral therapy improve survival rates.

Candidíase oral e leucoplasia pilosa como marcadores de progressão da infecção pelo HIV em pacientes brasileiros

Candidíase oral (CO) e leucoplasia pilosa (LP) são importantes indicadores da progressão da infecção pelo vírus da imunodeficiência humana (HIV) para o quadro de AIDS, principalmente em locais onde exames específicos são inacessíveis. OBJETO: Relacionar CO e LP ao número de células CD4+ e à carga viral (CV) em pacientes brasileiros HIV-positivos, confirmando-as como marcadores clínicos confiáveis de progressão da doença. FORMA DE ESTUDO: Coorte longitudinal. CASUÍSTICA E MÉTODO: Avaliamos prospectivamente 124 pacientes HIV-positivos, isentos de terapia antiretroviral. Todos foram submetidos a exame ORL, dosagem de células CD4+ e CV, sendo divididos em dois grupos: P e A, de acordo com a presença ou ausência de CO e LP. Depois de seis meses, os pacientes do grupo A foram subdivididos nos subgrupos P6 (presença de lesões) e A6. Dosamos novamente CD4+ e carga viral. Os resultados foram analisados estatisticamente. RESULTADOS: No grupo P (43 pacientes, 28 CO e 15 LP) a contagem de células CD4+ foi menor e a carga viral maior em relação ao grupo A (p<0,001). Após 6 meses, 15 dos 81 pacientes do grupo A foram excluídos por iniciarem terapia antiretroviral. Dezoito (11 CO e 7 LP), passaram a compor o grupo P6. Os demais, sem lesões, compuseram o grupo A6. A contagem de células CD4+ no grupo P6 foi menor (p< 0,001) que no grupo A6. O inverso ocorreu com a carga viral. DISCUSSÃO E CONCLUSÃO: CO e LP indicam contagem de células CD4+ abaixo de 300 cels/mm³ e carga viral elevada, sendo marcadores clínicos confiáveis da progressão da doença.

Laryngeal pathology in the acquired immunodeficiency syndrome: diagnostic and therapeutic dilemmas

The acquired immunodeficiency syndrome has produced a growing population of patients who, because of their associated immune system compromise, are prone to opportunistic infections and neoplastic diseases. The larynx, with its relatively inaccessible yet critical anatomic location, is a site in which these processes can produce clinical dilemmas, with respect to diagnosis as well as to therapy. By presenting 4 cases involving unusual laryngeal problems in patients infected with the human immunodeficiency virus (HIV), we emphasize these inherent diagnostic and therapeutic problems. Otolaryngologists must be familiar with the many diagnostic possibilities and therapeutic alternatives when HIV-infected patients present with laryngeal complaints.

Otolaryngologic manifestations of human immunodeficiency virus infection

Patients infected with HIV have become a steadily increasing part of most medical practices. Because most patients with HIV-related problems have manifestations in the head and neck, it is important that these be understood and recognized. This article briefly reviews the various otolaryngologic manifestations of HIV infection, including otologic, nasal, and paranasal sinus; oral cavity, pharynx, and larynx; and the neck.

Stridor as a manifestation of supraglottic carcinoma in a patient with AIDS

As patients with human immunodeficiency virus (HIV) infection are living longer, the differential diagnosis of stridor in acquired immunodeficiency syndrome (AIDS) patients should be broadened to include malignancies in addition to the common causes of infections and functional airway abnormalities. Herein, we describe a 50-year-old woman with AIDS who presented with stridor secondary to supraglottic squamous cell carcinoma.

Second primary malignancies in the head and neck cancer patient

With improvements in locoregional control, the problem of second primary malignancies is rapidly being pushed to the forefront of head and neck oncology. While the constant long-term risk for the head and neck cancer patient has been well established, efforts at prevention, early detection, and treatment have been somewhat futile. Recent advances in genetic predisposition, biomarkers, photodiagnostic imaging, and differentiation therapy may soon offer improved outcomes. The literature is reviewed and current research is presented regarding the history, epidemiology, etiology, diagnosis, and treatment of second primary malignancies.