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      Oral lesions associated with human immunodeficiency virus in 75 adult patients: a clinical study

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          Abstract

          Objectives

          The objective of this study was to investigate the presence of oral lesions in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in a descriptive cross-sectional study, and to establish their presence according to levels of CD4+ cells (including the CD4+/CD8+ cell ratio).

          Materials and Methods

          A total of 75 patients infected with HIV were included. Oral lesions were observed and classified using World Health Organization classification guidelines. Potential correlations between the presence and severity of oral lesions and CD4+ cells, including the CD4+/CD8+ cell ratio, were studied.

          Results

          The most frequent oral lesion detected was oral pseudomembranous candidiasis (80.0%), followed by periodontal disease (40.0%), herpetic lesions (16.0%), hairy leukoplakia (16.0%), gingivitis (20.0%), oral ulceration (12.0%), Kaposi's sarcoma (8.0%), and non-Hodgkin's lymphoma (4.0%). The CD4+ count was <200 cells/mm 3 in 45 cases (60.0%), between 200–500 cells/mm 3 in 18 cases (24.0%), and >500 cells/mm 3 in 12 cases (16.0%). The mean CD4+ count was 182.18 cells/mm 3. The mean ratio of CD4+/CD8+ cells was 0.26. All patients showed at least one oral manifestation.

          Conclusion

          There was no correlation between the CD4+/CD8+ cell ratio and the presence of oral lesions. The severity of the lesions was more pronounced when the CD4+ cell count was less than 200 cells/mm 3.

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          Most cited references25

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          Epidemiologic trends in head and neck cancer and aids in diagnosis.

          Head and neck squamous cell carcinoma is the sixth most common cancer worldwide predominately associated with tobacco use. Changing cause and increased incidence in oropharyngeal carcinomas is associated with high-risk types of human papilloma virus and has an improved survival. Optical devices may augment visual oral examination; however, their lack of specificity still warrants tissue evaluation/biopsy. Histologic factors of oral carcinomas are critical for patient management and prognostic determination. Clinical biomarkers are still needed to improve early detection, predict malignant transformation, and optimize therapies.
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            Oropharyngeal candidiasis in the era of antiretroviral therapy.

            Oropharyngeal candidiasis (OPC) remains a common problem in the HIV-infected population despite the availability of antiretroviral therapy (ART). Although Candida albicans is the most frequently implicated pathogen, other Candida species also may cause infection. The emergence of antifungal resistance within these causative yeasts, especially in patients with recurrent oropharyngeal infection or with long-term use of antifungal therapies, requires a working knowledge of alternative antifungal agents. Identification of the infecting organism and antifungal susceptibility testing enhances the ability of clinicians to prescribe appropriate antifungal therapy. Characterization of the responsible mechanisms has improved our understanding of the development of antifungal resistance and could enhance the management of these infections. Immune reconstitution has been shown to reduce rates of OPC, but few studies have evaluated the current impact of ART on the epidemiology of OPC and antifungal resistance in these patients. Preliminary results from an ongoing clinical study showed that in patients with advanced AIDS, oral yeast colonization was extensive, occurring in 81.1% of the 122 patients studied, and symptomatic infection occurred in one-third. In addition, resistant yeasts were still common, occurring in 25.3% of patients colonized with yeasts or with symptomatic infection. Thus, OPC remains a significant infection in advanced AIDS, even with ART. Current knowledge of the epidemiology, pathogenesis, clinical presentation, treatment, and mechanisms of antifungal resistance observed in OPC are important in managing patients with this infection and are the focus of this review. Published by Mosby, Inc.
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              HIV virology and pathogenetic mechanisms of infection: a brief overview

              Studies on HIV virology and pathogenesis address the complex mechanisms that result in the HIV infection of the cell and destruction of the immune system. These studies are focused on both the structure and the replication characteristics of HIV and on the interaction of the virus with the host. Continuous updating of knowledge on structure, variability and replication of HIV, as well as the characteristics of the host immune response, are essential to refine virological and immunological mechanisms associated with the viral infection and allow us to identify key molecules in the virus life cycle that can be important for the design of new diagnostic assays and specific antiviral drugs and vaccines. In this article we review the characteristics of molecular structure, replication and pathogenesis of HIV, with a particular focus on those aspects that are important for the design of diagnostic assays.
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                Author and article information

                Journal
                J Korean Assoc Oral Maxillofac Surg
                J Korean Assoc Oral Maxillofac Surg
                JKAOMS
                Journal of the Korean Association of Oral and Maxillofacial Surgeons
                The Korean Association of Oral and Maxillofacial Surgeons
                2234-7550
                2234-5930
                December 2017
                26 December 2017
                : 43
                : 6
                : 388-394
                Affiliations
                [1 ]Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon.
                [2 ]Department of Oral Medicine and Diagnosis, School of Dentistry, Lebanese University, Beirut, Lebanon.
                Author notes
                Corresponding author: Antoine Berberi. Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Campus Rafic Hariri, Hadath 5208-116, Lebanon. TEL: +961-3-731173, FAX: +961-4-533060, anberberi@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-7658-1361
                https://orcid.org/0000-0001-5073-6882
                Article
                10.5125/jkaoms.2017.43.6.388
                5756795
                29333368
                a4074c24-2bb5-4250-a1b9-3b0966156e56
                Copyright © 2017 The Korean Association of Oral and Maxillofacial Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 July 2017
                : 12 September 2017
                : 20 September 2017
                Categories
                Original Article

                acquired immunodeficiency syndrome,cd4+,hiv,oral lesions

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