HIV Mouth Sores: Types of Sores and Symptoms - Verywell Health
HIV Mouth Sores: Types of Sores and Symptoms - Verywell Health |
| HIV Mouth Sores: Types of Sores and Symptoms - Verywell Health Posted: 02 Mar 2021 10:57 AM PST /GettyImages-720071237-e652e2cf41a048aaa5fc8fa7e75c147d.jpg) Mouth sores affect between 70 to 90% of people with human immunodeficiency virus (HIV) at some stage in the disease. In fact, the various sores, plaques, lesions, and ulcers that are commonly seen in people with HIV may be an early sign of infection. However, in other cases, they could be an indication of disease progression to acquired immunodeficiency syndrome (AIDS). The mouth sores that can result from HIV can substantially decrease a person's quality of life, and the presence of these lesions are—in some cases—associated with their psychological health. Mohd Akhir / EyeEm / Getty Images Aphthous UlcersAphthous ulcers are canker sores. They can occur in anyone but are more common—and tend to be more severe and recurrent—in people with HIV. While the terms are often used interchangeably, "canker sores" and "cold sores" aren't the same thing. The primary symptoms of aphthous ulcers are most often found on the inner surface of the cheeks and lips, tongue, the upper surface of the mouth, and the base of the gums, and may include:
There may also be accompanying symptoms of aphthous ulcers like:
Diagnosis can be tricky because the sores can look like herpes simplex virus (HSV) ulcers. But medication for HSV ulcers doesn't work on canker sores, so that's one way of ruling that out as a possibility. In some cases, larger aphthous ulcers may require a biopsy to ensure that they are not cancerous. Canker sores are treated with:
Aphthous Ulcers Are Not ContagiousThis comes down to the confusion between canker sores (aphthous ulcers) and cold sores. Cold sores are highly contagious, thanks to a virus. Canker sores, on the other hand, are not contagious. Herpes Simplex Virus (HSV)There are two types of HSV: HSV-1 and HSV-2. Approximately 70% of people with HIV have HSV-2, while 95% have either HSV-1 or HSV-2. Cold sores are more commonly linked to HSV-1 but can also involve HSV-2 when transmitted during oral sex. Outbreaks of HSV cold sores tend to be more common and severe whenever the immune system is suppressed. The cold sores start out as lesions on lips and oral mucosa, then evolve in stages from papule (a solid, raised bump) to vesicle (a small, fluid-filled sac), to ulcer, and eventually crust. There are several different stages of HSV cold sores, each with its own set of symptoms. Before a cold sore becomes visible, symptoms may include:
Then, before the cold sore blisters appear, accompanying symptoms may include:
Lesions or a rash may form on your:
It's also possible to have a cluster of HSV blisters, which is known as an outbreak. This may include:
In most cases, doctors and nurses can diagnose oral herpes simply by looking at it in an examination. Sometimes, they'll want to run tests on a sample of the sore, including:
HSV cold sores are typically treated with antiviral medicines like acyclovir, famciclovir, and valacyclovir. There are also antiviral skin creams, but they are costly and barely shorten the outbreak. How Long Do HSV Sores Last?The sores typically last for one to two weeks without treatment but can reoccur because HSV persists in the body. Oral CandidiasisOral candidiasis—also known as oral thrush—is the most common oral opportunistic infection affecting people with HIV or AIDS. In fact, it's the first sign of HIV in around 10% of cases. Oral candidiasis involves the same type of fungus (Candida) that causes vaginal yeast infections. The primary symptoms of candidiasis in the mouth and throat may include:
Oral candidiasis typically takes the form of white plaques that affect the oral mucosa, tongue, and both hard and soft palates. The plaques are usually:
Diagnosis of oral candidiasis typically involves an examination based on appearance and other risk factors. If, after scraping, the base of the plaques become red, inflamed, and start bleeding, it typically results in an oral thrush diagnosis. The sores are typically treated with topical or oral antifungals. Candidiasis and AIDSCandidiasis is an AIDS-defining condition when it occurs in the:
Esophageal candidiasis is one of the most common infections in people living with HIV/AIDS. Oral Hairy Leukoplakia (OHL)Oral hairy leukoplakia (OHL) can occur in up to 50% of people with HIV who are not under any HIV treatment (ART). OHL is also a common first symptom in people with HIV. The onset of OHL is directly linked to immune suppression and tends to occur when the CD4 count drops below 300. OHL is due to an infection with the Epstein-Barr virus. OHL can also occur with other forms of severe immunodeficiency—like chemotherapy patients—or those who have had an organ transplant or leukemia. While OHL is sometimes asymptomatic, the noticeable symptoms include:
Some patients may experience accompanying symptoms, including:
What Do OHL Lesions Look Like?OHL lesions may vary in severity and appearance — with some being smooth, flat, and small, while others are irregular, "hairy," or "feathery" with prominent folds or projections. In addition to the tongue, the sores can also be found on the buccal mucosa, and/or the gingiva. Like oral candidiasis, OHL lesions cannot be scraped away. Diagnosis takes place via a testing kit looking for:
OHL may not require any specific treatment other than antiretroviral therapy (ART), though some options include:
HIV-Associated GingivitisHIV-associated gingivitis—more commonly referred to as periodontal disease in people with HIV—takes two forms:
HIV-associated gingivitis is more commonly seen with advanced infection when the CD4 count is approaching 200. The symptoms of HIV-associated gingivitis include:
If left untreated, the cratered ulcers can trigger severe pain and tooth loss. Many patients have had reasonable success with the following protocol:
In some cases, antibiotics are added to the regimen. HIV-Associated Gingivitis vs. Regular GingivitisThe biggest indications that gingivitis is associated with HIV include:
Human Papillomavirus (HPV)Human papillomavirus (HPV) is most commonly associated with genital warts but can also occur in the mouth as a result of oral sex. HPV is the most common sexually transmitted infection in the United States and comes in more than 100 different varieties. Approximately 10% of men and 3.6% of women have oral HPV, which can affect the mouth and back of the throat. It is also thought to cause 70% of oropharyngeal cancers in the United States. Oral HPV does not have any symptoms—which is why it can be so easy to pass it along to other people without realizing it. If someone has HPV for an extended period of time, it could result in oropharyngeal cancer. The symptoms of oropharyngeal cancer may include:
Not only does an oral HPV infection not have any symptoms, but there's also no way to test for it. If you're experiencing some of the symptoms listed above and are concerned, it's a good idea to talk to your doctor about it. They'll examine your mouth and may order additional tests like a biopsy and imaging. In most cases, oral HPV infections go away on their own without treatment within two years and typically don't cause any health problems. HPV VaccinationsCenters for Disease Control and Prevention (CDC) recommendations:
Kaposi Sarcoma (KS)Kaposi sarcoma (KS) is the most common AIDS-defining cancer. At one point, it was frequently seen in people with AIDS, but levels decreased substantially as effective ART became available, and there were fewer people living with HIV experiencing CD4 counts falling to very low levels. Still, KS remains a strong indicator of disease progression. KS is due to an infection with Human herpesvirus-8 (HHV8). KS can affect any part of the body and causes patches or lesions of abnormal tissue to grow under the skin, which are usually red or purple in color. This can occur:
These patches are made of cancer cells, blood vessels, and blood cells. While the KS skin lesions may not cause symptoms, they can spread to other parts of the body in people with HIV/AIDS. This becomes particularly serious if they spread to the digestive tract or lungs, as they can cause bleeding and make it hard to breathe. In addition to a physical examination focusing on the lesions, your doctor may order additional tests to diagnose KS, including:
The treatment options for KS depend on whether the person is immunosuppressed, the number and location of their tumors, and their other symptoms (including shortness of breath, coughing up blood, and leg swelling). KS treatments include:
Unfortunately, in some cases, tumors and lesions may return after treatment. A Word From VerywellMany of the above-listed conditions can be avoided or resolved with the use of antiretroviral drugs—a major step forward in dealing with HIV/AIDS. In 2015, the Strategic Timing of AntiRetroviral Treatment (START) study—the first large-scale randomized clinical trial to establish that earlier antiretroviral treatment benefits all HIV-infected individuals—released new data. The findings included the fact that if HIV-infected individuals start taking antiretroviral drugs sooner, when their CD4+ T-cell count is higher, instead of waiting until the CD4+ cell count drops to lower levels, they have a considerably lower risk of developing AIDS or other serious illnesses.  |
| A Covid Vaccine Side Effect, Enlarged Lymph Nodes, Can Be Mistaken for Cancer - The New York Times Posted: 01 Mar 2021 12:14 PM PST  Coronavirus vaccinations can cause enlarged lymph nodes in the armpit or near the collarbone, which may be mistaken for a sign of cancer. As vaccines are rolled out across the country, doctors are seeing more and more of these swollen nodes in recently immunized people, and medical journals have begun publishing reports aimed at allaying fears and helping patients avoid needless testing for a harmless condition that will go away in a few weeks. The swelling is a normal reaction by the immune system to the vaccine, and occurs on the same side as the arm where the shot was given. It can also occur after other vaccinations, including those for flu and the human papillomavirus (HPV). Patients may or may not notice it. But the enlarged lymph nodes show up as white blobs on mammograms and chest scans, resembling images that can indicate the spread of cancer from a tumor in the breast or elsewhere in the body. "I am particularly eager to get the word out to all the patients undergoing surveillance after successful prior treatment of cancer," said Dr. Constance D. Lehman, an author of two journal articles on the problem and the chief of breast imaging at the Massachusetts General Hospital. "I can't imagine the anxiety of getting the scan and hearing, 'We found a node that is large. We don't think it's cancer but can't tell,' or worse, 'We think it might be cancer.'" The swelling in the armpit was a recognized side effect in the large trials of the Moderna and Pfizer-BioNTech vaccines. In Moderna's study, 11.6 percent of patients reported swollen lymph nodes after the first dose, and 16 percent after the second dose. Pfizer-BioNTech appeared to have a lower incidence, with 0.3 percent of patients reporting it. But those figures reflect only what patients and their doctors noticed, and radiologists say that the real rate is probably higher, and that many more cases are likely to show up on imaging like mammograms, or M.R.I.s or CT scans. The condition was not listed among the reported side effects in a briefing document from the Food and Drug Administration about the Johnson & Johnson Covid vaccine. On Saturday, the agency authorized the company's vaccine for emergency use. Dr. Lehman said it was important for imaging centers to ask patients if they have had Covid inoculations and to record the date of the shot and the arm in which it was given. Her clinic includes this advisory in a letter to patients whose screenings detect swelling but no other abnormalities: "The lymph nodes in your armpit area that we see on your mammogram are larger on the side where you had your recent Covid-19 vaccine. Enlarged lymph nodes are common after the Covid-19 vaccine and are your body's normal reaction to the vaccine. However, if you feel a lump in your armpit that lasts for more than six weeks after your vaccination, you should let your health care provider know." One way people could avoid the problem would be to postpone routine mammograms and other imaging for at least six weeks after the last dose of vaccine, according to an article by an expert panel in the journal Radiology, published on Wednesday. A professional group, the Society of Breast Imaging, offers similar advice: "If possible, and when it does not unduly delay care, consider scheduling screening exams prior to the first dose of a Covid-19 vaccination or 4-6 weeks following the second dose of a Covid-19 vaccination." But the expert panel also cautioned that nonroutine imaging, needed to help deal with an illness or other symptoms that might indicate cancer, should not be delayed. Nor should immunization. People who have cancer are generally advised to be vaccinated against the coronavirus, particularly because they are at higher risk of dying from Covid than the general population. But some cancer treatments may interfere with the body's ability to respond fully to the vaccine, and the American Cancer Society advises patients to consult with their oncologists about vaccination. In recently vaccinated people who have cancer and develop enlarged lymph nodes, it may be necessary to perform more tests, including a biopsy of the nodes, Dr. Lehman said. She described one patient with a newly diagnosed breast tumor who had swollen lymph nodes on the same side, and had recently received a Covid shot in the arm on that side. A biopsy was performed, an important step to determine whether there were malignant cells in the nodes that would then help decide a course of treatment. It was negative for cancer. The vaccine had most likely caused the swelling. In another case, a woman who previously had cancer in her right breast had a routine mammogram that showed an enlarged lymph node in her left armpit, and no other abnormality. She'd recently received a Covid vaccination in the left arm. Doctors determined that no more tests would be needed unless the swollen nodes lasted more than six weeks. In a man with a history of bone cancer, a chest CT scan performed as part of a follow-up found swollen lymph nodes in one armpit — on the side where he'd recently had a Covid inoculation. Nothing else was wrong and no further tests were needed. The same decision was made for similar findings in a recently vaccinated man who had a chest CT to screen for lung cancer, and in a woman with a history of melanoma. For patients undergoing treatment for cancer in one breast, Dr. Lehman said, the Covid shot should be given in the arm on the other side. The vaccine can also be injected into the thigh to prevent any issues with lymph node swelling. "This could really impact a lot of people if we don't start recording vaccination status immediately at imaging centers," Dr. Lehman said. "I also want cancer patients to know they can get the vaccine on the opposite side or even the leg to avoid confusion."  |
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