Doctors treating patients with HIV should be cognisant of the oral problems that occur in these patients. While their immunological status is reasonable, the majority of these patients will not develop the classically recognised oral manifestations of HIV disease, such as florid pseudomembranous candidosis, Kaposi's sarcoma or oral hairy leukoplakia. However, the patients are likely to have oral problems associated with their long-term treatment.

A recent study assessed the long-term use of highly active antiretroviral therapy (HAART) on the oral health of HIV-infected patients. The multiple logistical regression analysis, controlling for duration of HIV infection, CD4 count, smoking habits and alcohol consumption, showed patients have a greater risk of developing oral lesions with long-term use than with short-term use of HAART.1

Patients with HIV can develop profound oral dryness with a resultant increase in traumatic mucosal ulceration and pain, as well as an increased likelihood of developing dental caries. Furthermore, these patients have an increased risk of periodontal disease, dental decay, oral infections and poor healing after periodontal treatment or extraction. It is advisable for the treating clinician to discuss with the patient the potential dental adverse effects of the long-term use of HAART. Early referral to a dentist for appropriate management is important, particularly for the establishment of an effective dental preventive program. The key to oral health management would be six-monthly reviews by a general or special-needs dentist with an interest and training in the dental management of patients with HIV.


Michael McCullough

Chair, Therapeutics Committee, Australian Dental Association