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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: ♦ ♦ ♦ ♦ 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
5–12 | Clinical Manual for Management of the HIV-Infected Adult/2006 Herpes Simplex Virus HSV lesions occur on the palate, gingivae, or other mucosal surfaces. They appear as single or clustered vesicles and may extend onto adjacent skin of the lips and face to form a large herpetic lesion. Lesions tend to be more common, persist longer, recur more often, and be larger and more numerous in HIV-infected patients, especially those with significant immunosuppression, than in healthy individuals. Empiric treatment with famciclovir, valacyclovir, or acyclovir is appropriate. For more details, see chapter Herpes Simplex, Mucocutaneous. Aphthous Ulcers Aphthous ulcers are eroded, well-defined lesions surrounded by erythema, ranging in size from
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Table of Contents Clinical Manual f
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Clinical Manual for Management of t
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Preface—About this Manual | Clini
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Previous Editions Atlanta Contribut
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♦ ♦ ♦ ♦ ♦ | Clinical Manu
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1-2 | Clinical Manual for Managemen
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Initial Physical Examination Backgr
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Genitals/Rectum • Inspect the gen
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Initial and Interim Laboratory and
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Section 1—Testing and Assessment
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Patient Education ♦ ♦ ♦ ♦ D
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Section 2—Health Maintenance and
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References ♦ ♦ ♦ ♦ ♦ ♦
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Occupational Postexposure Prophylax
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P: Plan Laboratory Testing Provide
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For hepatitis C, no recommended pro
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as hepatitis C or another sexually
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for treatment is appropriate, and b
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contact with the patient. Patients
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tablet daily of trimethoprim-sulfam
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Opportunistic Infection Prophylaxis
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Discontinuing Primary Prophylaxis P
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Latent Tuberculosis Background Late
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INH may cause liver toxicity and it
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Patient Education ♦ ♦ ♦ ♦
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Reducing Maternal-Infant HIV Transm
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Some states require written informe
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contraindicated during pregnancy be
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Section 3—Antiretroviral Therapy
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Nelfinavir (Viracept) Adequate drug
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Page 202 and 203: Eye Problems Background The immunos
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Page 210 and 211: Fever Background Although fever may
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Page 214 and 215: Lymphadenopathy Background Lymphade
Page 216: Treatment Treatment will depend on
Page 222 and 223: Neurologic Symptoms Background The
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Page 226 and 227: Pulmonary Symptoms Background Short
Page 228: Treatment Once the diagnosis is mad
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Page 240: Maintenance therapy Use caution whe
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Cervical Dysplasia Background Cervi
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Patient Education ♦ ♦ ♦ ♦ P
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Cryptosporidiosis Background Crypto
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Gonorrhea and Chlamydia Background
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Treatment of Gonorrhea Treatment op
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Hepatitis B Infection Background He
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♦ ♦ ♦ ♦ ♦ Some patients t
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Hepatitis C Infection Background He
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pregnancy. Ribavirin is teratogenic
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Herpes Simplex, Mucocutaneous Backg
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References ♦ ♦ ♦ ♦ ♦ Cent
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Kaposi Sarcoma Background Kaposi sa
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Treatment Treatment of KS is not co
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Molluscum Contagiosum Background Mo
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Mycobacterium avium Complex Backgro
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Table 1. Interactions between Rifab
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Mycobacterium tuberculosis: Treatme
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P: Plan Diagnostic Evaluation Durin
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Table 1. Regimens for Treatment of
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Rifabutin may be substituted for ri
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Non-Hodgkin Lymphoma Background Non
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Patient Education ♦ ♦ ♦ ♦ S
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Toxoplasmosis Background Toxoplasma
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♦ Atovaquone 1,500 mg orally twic
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Linear Gingival Erythema Background
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Background Necrotizing ulcerating p
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Oral Health Background Examination
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Maxillary Tori; Mandibular Tori S:
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Periodontal Disease Background The
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Oral Hairy Leukoplakia Background O
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Oral Ulceration Background Oral ulc
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Oral Warts Background Oral warts ar
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Anxiety Disorders Background Anxiet
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Patient Education ♦ ♦ Behaviora
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Insomnia Background Insomnia is a c
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Suicidal Ideation Background Transi
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Section 8—Neuropsychiatric Disord
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P: Plan ♦ ♦ ♦ ♦ ♦ Check t
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Correctional Settings Background Ca
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Adherence Adherence is one of the m
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Karnofsky Performance Scale Backgro
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