HIV/AIDS In Pakistan

 

 

Dr.Mahreen Shahzad
Associate Professor & Head
Oral Diagnostic & Medicine Department
SIR SYED COLLEGE OF MEDICAL SCIENCES

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HIV is documented as a health concern in Pakistan with amount of cases increasing yearly. Fairly high drug use and lack of acceptance that non-marital sex is common in the society have allowed the HIV epidemic to take hold in Pakistan, largely among, male, female and transgender sex workers  also the repatriate migrant workers. HIV infection can lead to AIDS that inevitably become a major health issue which is ultimately fatal in nature.

The National AIDS Control Programme’s latest figures show that by the mid of first decade in new millennium, the number of HIV cases have increased to approximately 0.102 million. This number was estimated little over 4,000, as the HIV cases reported since 1986. The UN and government estimated the number of HIV/AIDS cases around 97,000 ranging from a lowest estimate of 46,000 to a highest estimate of 210,000.

HIV is also known as RNA retrovirus,formerly termed ‘human T lymphotrophic virus 3,produces HIV infection which eventually results in damage to T lymphocytes, especially those that are CD4, and thus causes immunodeficiency. This predisposes to infection with fungi, viruses, mycobacteria or parasites, and the appearance of disease,at which the condition is termed HIV disease.This then progresses over time to the acquired immunodeficiency syndrome (AIDS),defined as a CD4 T lymphocyte count at or below 200 cells/ul in the presence of HIV infection

 

HIV disease has an effect over the entire body. It is not practical in the present situation for any health personnel dealing with diagnosis and treatment in humans to not encounter this alarming disease and its manifestations. Thus it becomes very important to be aware of the various forms of HIV manifestations.

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Oral manifestations of HIV:

Oral health is an important component of the overall health status in HIV infection. Knowledge of the variety of oral disorders which can develop during the course of HIV infection and coordination of health care services between a physician and a dentist may improve the overall health of the patient. The variety of oral manifestations is very huge in HIV-AIDS.

Oral manifestations of HIV infection occur in 30–80% of the affected patient population. The overall frequency of oral manifestations in HIV disease has altered since the arrival of ART.

The different oral manifestations can be categorized into;

1. Infections: bacterial, fungal, viral


2. Neoplasms: Kaposi’s sarcoma, non-Hodgkin’s lymphoma


3. Immune mediated: major aphthous, necrotizing stomatitis


4. Others: parotid diseases, nutritional, xerostomia


5. Oral manifestations as adverse effects of antiretroviral therapy.

(Oral manifestations are categorized specifically in table 1 and 2 according to its frequency)

There is no specific oral lesion which is associated only with HIV-AIDS but there are certain manifestations like oral candidiasis, oral hairy leukoplakia (OHL) which are associated  recurrently and are considered AIDS-defining diseases and have also been integrated in the clinical classification of HIV by CDC (Centre of Disease Control and Prevention) in category B.

Table no1:

GROUP 1: LESION STRONGLY ASSOCIATED WITH HIV INFECTION
•      Candiasis	•        HIV gingivitis
a. Erythematous	•        Necrotising ulcerative gingivitis
b. Hyperplastic	•        HIV periodontitits
c.Thrush  (fig 1)	•        Kaposi sarcoma  (fig 3)
•      Hairy leukoplakia (EBV)  (fig 2)	•        Non-Hodgkin’s lymphoma