Clinical Manual for Management of the HIV-Infected ... - myCME.com

Mouth and Throat
The oral cavity is one of the most common areas of
symptoms in patients with HIV infection. Conditions
that arise in the oral cavity may be infectious, benign
inflammatory, neoplastic, or degenerative processes.
S: Subjective
The patient may complain of white patches and red
areas on the dorsal surface of the tongue and the palate,
decreased taste sensation, white lesions along the lateral
margins of the tongue, ulcerated lesions, nonhealing
lesions at the corners of the mouth, sore gums, loose
teeth, dysphagia, or odynophagia.
Obtain the following information during the history:
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Medications (prescription and over-the-counter) and
herbal supplements (note that zalcitabine, dapsone,
and other drugs may cause aphthous ulcers)
Usual oral hygiene (toothbrushing, tongue brushing
or scraping, flossing, use of mouthwash)
Date of last dental examination
Involuntary weight loss
O: Objective
Recent CD4 count and HIV viral load are important
measures of immunosuppression to determine whether
the patient is at risk for opportunistic infections as
causes of oral complaints.
Thorough examination of the mouth and throat with
a tongue depressor and a good light is mandatory.
Observe for white patches or plaques on the mucous
membranes that can be partially removed by scraping
with a tongue blade (candidiasis). Examine the dorsal
surface of the tongue and hard and soft palates for red,
flat, subtle lesions (erythematous candidiasis). Check
for ulcerations, inflamed gums, and loose teeth. Look
for discoloration or nodular lesions on the hard palate
(Kaposi sarcoma). Look for ribbed, whitish lesions on
the lateral aspects of the tongue that cannot be scraped
off (oral hairy leukoplakia). Check the pharynx for
adenotonsillar hypertrophy. Rule out HIV-unrelated
causes of pharyngitis, including streptococci or
respiratory viruses.
Section 5—Complaint-Specific Workups | 5–11
A: Assessment and Plan
Perform biopsy, culture, and potassium hydroxide
(KOH) preparation of lesions as indicated.
Oral Candidiasis (Thrush)
Oral candidiasis is most likely to occur when the CD4
count is