Case Series of HIV-Associated Oral Lesions Among Antiretroviral-Naive Patients During the COVID-19 Pandemic

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has a serious impact on HIV-infected individuals due to limited access to treatment services. This report aimed to describe four cases of oral lesions in HIV-infected antiretroviral-naive patients found during the COVID-19 pandemic.

Case: Four patients, males, with an age ranged from 29 to 53 years, came to Oral Medicine Department with chief complaints of lesions on their mouth. They had postponed their visit to healthcare services due to limited access during pandemic. Three patients had just been diagnosed with HIV and had not yet received anti-retrovirus, while 1 patient had not yet been detected with HIV. From the clinical examination and laboratory findings, we diagnosed the lesions with mucous patches, chronic atrophic candidiasis, angular cheilitis, necrotizing ulcerative gingivitis, linear gingival erythema, cytomegalovirus-associated ulcers, and oral hairy leukoplakia.

Case management: We gave chlorhexidine gluconate 0.2% mouthwash for mucous patches, nystatin oral suspension for chronic atrophic candidiasis, miconazole cream 2% for angular cheilitis, debridement with hydrogen peroxide 1.5% and rinsed with normal saline for necrotizing ulcerative gingivitis, and diphenhydramine hydrochloride and 0.2% chlorhexidine gluconate for CMV ulcers. All patients showed good clinical improvement after the treatments.

Conclusion: Oral lesions are still commonly found in HIV-infected patients during COVID-19 pandemic. Dentists remain to have a crucial role in the early diagnosis and treatment of HIV-associated oral lesions during COVID-19 pandemic that will have an impact on HIV treatments, also in implementing the Bali Declaration on oral health in HIV/AIDS 2019 to support UNAIDS goal to end AIDS by 2030.

Keywords: ARV-naive patients; COVID-19 pandemic; HIV; oral lesions.

Figure 1

Painless single ulcer, with a red base, white edges on the palate (A). Lesions healed in second visit, 14 days later (B).

Figure 2

White plaque with erythematous area on the palate, buccal mucosa right and left, and tongue (A–E). Fissured on the corners of the lip. Second visit (three weeks), the lesions disappeared (F–J).

Figure 3

Greyish white plaques on mandibular anterior gingiva, erosion on lower labial mucosa (A). Erosion on left buccal mucosa (B). Erosion on left buccal mucosa (C). The lesion has improved (7 days) (D–F).

Figure 4

Multiple ulcers on soft palate, oropharynx, uvula (A), single ulcer on ventrolateral of the tongue and white corrugated, adherent plaques on left lateral of the tongue (B) two months after first visit, the lesions improved (C and D).