What is the difference between HIV and AIDS?

The symptoms you exhibit to the doctor make it possible for him to make a presumptive diagnosis without doing any blood tests.  AIDS is a group of symptoms which, if seen to occur together, infer to the doctor that the patient may be suffering from the HIV virus.  The symptoms of AIDS include many different disease entities, but the most common ones are included in the Bangui definition.

What is the origin of the HIV virus?

The disease entity that later came to be known as AIDS seemed to pop out of nowhere about the year 1981.  For the general public, awareness began as a series of rumors that gay men were getting sick with illnesses that were rarely seen in modern America, and almost never seen in young men.  Many people, including some scientists and journalists attributed it to the gay lifestyle, since it seemed to be confined to that population.  In 1982, the term "AIDS" was first used to describe the syndrome.  It was not until 1984 when Dr. Robert Gallo claimed to have discovered the virus that it became widely known that AIDS was linked to a specific disease causing entity, and not simply to lifestyle issues. (In reality, the virus was first isolated at the Pasteur institute in France the year before, but the full implications of the discovery were not recognized at that time.)  As the biological characteristics of the virus were discovered over the next few years, scientists noted its similarity to SIV (simian immunodeficiency virus).  SIV was already a well known entity, and it began to be suspected that HIV was really a pre existing virus which made the jump from monkeys or apes to humans.  A 2006 news article tells the story of some modern biological sleuthing and confirms that the virus has been traced to a colony of chimpanzees in Cameroon (on the west coast of Africa). 

The epidemiology of AIDS in America (who has it, where it's been and where it's going)

According to CDC figures there have been nearly a million cases of HIV diagnosed in the United States since 1981, the year when the first cases of what would eventually become known as AIDS were reported to the Center for Disease Control (CDC).  It was not until 1984 that the virus was first isolated and determined to be the causative agent of the AIDS epidemic in the United States.

From the beginning of the AIDS epidemic in 1981 until the end of 1984, about 529,113 Americans died of their HIV infection.  As of the 2004 statistics, 9,443 children under age 13 were infected and a little over half of those have died.  From 1999 through 2004, the estimated number of AIDS cases decreased 68% among children.  A 2005 article in the New York times notes:

Current yearly statistics from the CDC (the statistics are always 2 years behind)

Infection and death rates In North America

To place these figures in perspective, a little over a half million North Americans died of AIDS between 1960 and 2004.  During the same period, more than 30 million North Americans died of cardiovascular related diseases and cancer.  Today, AIDS kills about 16,000 individuals annually in the United states.  Heart disease alone (not including other cardiovascular ailments) kills a little over 700,000 yearly, or over 38 times the number of AIDS related deaths.  These figures do not diminish the tragedy of the AIDS epidemic.  They serve, rather, to place it in context.

AIDS and Race in the US  (Click this link for the statistics)

During the 1990s, the epidemic shifted steadily toward a growing proportion of AIDS cases among black people, Hispanics and women, and toward a decreasing proportion in MSM (men having sex with men), although this group remains the largest single exposure group. Blacks and Hispanics have been disproportionately affected since the early years of the epidemic. In absolute numbers, blacks have outnumbered whites in new AIDS diagnoses and deaths since 1996, and in the number of people living with AIDS since 1998.  In 2003, blacks accounted for 50% of all HIV/AIDS cases diagnosed.

AIDS and Heterosexual transmission in the US  (Click this link for the statistics)

Comparing the pie chart above (for the cases diagnosed in 2004) with the bar chart on the right (showing cumulative cases since 1981), it is not difficult to see why men have outnumbered women by more than 3 to 1 over the course of the epidemic. The number of men having sex with men (MSM), along with the better than 3 to 1 ratio of male Intravenous Drug Users (IDU's) to female IDU's tends to skew the data toward a preponderance of men. (The 3 to 1 IDU figure is computed by adding the Male IDU and the MSM plus IDU figures).  Click here for reference.

Normal vaginal sexual intercourse between a man and a woman is the most important means of transmitting HIV to women.  One can see this by looking at the pie chart above.  Surprisingly, however, it is a less important factor in the spread of the virus from women to men.  Men are approximately one third less likely to contract the HIV virus from an infected woman than the reverse.  Women are  more prone to infection with the virus due to the nature of their anatomy and physiology than are men.  This has implications for the spread of the disease in the western world.  (Anal sex, on the other hand, exposes the participants, both male and female, to a higher risk of infection than a woman having vaginal sex due to the more easily abraded nature of the lining of the rectum and intestine, a higher probability of abrasions of the skin of the penis, and a higher probability of bacterial infections.)  

Women are the key to limiting the epidemic

Still, there is little doubt that heterosexual intercourse is the predominant mode of transmission for the HIV virus worldwide. For reasons explained below, the continent with most serious AIDS epidemic is Africa with an overall infection rate of 9% of the entire population and over one third of the population of some African nations infected with the virus.  

A note on the association of HIV with other STD's

As the sexual revolution in the US and Europe began to overtake traditional sexual morality, it started to become obvious that there was an association between the increase in the prevalence of sexually transmitted diseases and the transmissibility of the HIV virus.  This association is out of proportion to the actual prevalence of HIV versus the prevalence of the unrelated STD's.  In other words, persons who were infected with diseases like syphilis, gonorrhea, Chlamydia and herpes type II were more likely to pass the HIV virus along to their sexual partners than persons infected with the HIV virus alone.  

At first glance, this makes sense.  The presence of these diseases produces genital ulcers which allow fluids containing HIV to be transmitted to or from either of the individuals engaged in sexual relations.  However, the degree of transmissibility appears to go beyond the presence of genital ulcers suggesting that the mere presence of these diseases in persons also infected with HIV increases the likelihood of transmission of HIV.  The exact mechanism for this synergistic effect is not yet apparent, however, it is clear that there is an increased incidence of viral shedding associated with coexisting STD infections.  A report was published by researchers from the University of North Carolina School of Medicine in July 1997 about the results of their study in Malawi [1]. Briefly, they found that the semen of men infected by both HIV and other venereal diseases such as gonorrhea contains eight times as much HIV as that of patients infected by HIV alone. When HIV-infected men were given antibiotics to treat other STDs (Sexually Transmitted Diseases) the amount of HIV in their semen fell dramatically, reducing the chances of them infecting their partners.  Click here for a well documented and very technical paper on this subject.

[1] Myron S Cohen .Sexually transmitted diseases enhance HIV transmission:  No longer a hypothesis. The Lancet 1998 Volume 351, Issue (Supplement III) pages 5-7

You, your dentist and AIDS (The Acer case)

In September of 1990, Doctor David Acer, a dentist in a small town in Florida died of AIDS.  Before his death he sent a letter to all of his patients, informing them of his health status and urging them to take an HIV test. Acer reassured them that he had always followed standard infection-control procedures. Altogether, five deaths have been blamed on the transfer of HIV from Doctor Acer to his patients.

Since that time, there have been no undisputed cases of HIV transfer from any dentist to any patient.   In addition, there have been no documented instances of dental personnel contracting HIV from their patients. 

Even before the wide dissemination of "universal precautions", when dentists and hygienists did not routinely wear gloves or masks, neither they, nor their patients infected each other in spite the virtual certainty the virus was present in a percentage of both the patients and the dental personnel.  Bear in mind that dental personnel all over the country frequently puncture their skin accidentally with dirty dental needles, handpiece burs and other sharp instruments.  If there were a perceptible risk in transmitting the AIDS virus in the dental setting, there is no question that some dental personnel would have been occupationally infected by now! 

A note on the spread of AIDS in third world countries

It is very difficult for Americans to understand the huge cultural differences between western civilization and those cultures in which the term "civilization" does not have the same meaning as it does in Europe, Australia, North America and other first world nations.  These differences permeate every aspect of the lives of the individuals in the various cultures, from everyday thought patterns to the manner in which they govern themselves. They manifest especially in the less formal aspects of peoples' lives such as their sexual practices and patterns of drug use, both of which may vary significantly from western cultural traditions.  

One African bright spot is Uganda.  There, the epidemic has been nearly stopped by a campaign promoting abstinence. 

"According to a U.S. Agency for International Development study, in Uganda "national HIV prevalence peaked at around 15 percent in 1991, and had fallen to five percent as of 2001. This dramatic decline in prevalence is unique worldwide."

In the mid-1980s, when it became clear that AIDS was on the rise in Uganda, President Yoweri Museveni adopted a program that, as Arthur Allen has written in The New Republic, "would become known as ABC, for Abstain, Be faithful or wear a Condom -- very much in order of emphasis."

According to a study of one Ugandan district, almost 60 percent of youths age 13-16 reported engaging in sexual activity in 1994, but by 2001, the number had plummeted to less than 5 percent. The USAID study reports that compared with men in other sub-Saharan African countries, Uganda males are "less likely to have ever had sex (in the 15-19-year-old range), more likely to be married and keep sex within marriage, and less likely to have multiple partners."

The effect on HIV rates has been nearly miraculous. Researcher Rand Stoneburner estimates that Uganda's approach has been almost as effective as an HIV vaccine. "  (Rich Lowry Dec 6, 2002)  (click here for the stats)

One should also note that there is some controversy about the reported incidence of HIV on the African continent.  The diagnosis in most areas is based on the Bangui definition--- the complex of symptoms (AIDS) exhibited by the patient--- rather than by the serological (blood) test which is the definitive test used in Western countries.  As discussed above, numerous diseases that are endemic in Africa may produce symptoms identical to those seen in actual HIV infection.  As a result, there is a substantial chance that the reported incidence of HIV in Africa may be markedly overstated, although the controversy is in the degree and significance of the over reporting.  There is, understandably, a great deal of anger when a loved relative or friend is reported as having died of AIDS when the family knows that person has never engaged in behaviors known to increase the risk of contracting the virus.  

Latin America

Outside of Africa, many other third world countries have customs and practices that can appear just as exotic to American and European eyes.  Upon visiting Honduras, I was surprised to learn from the Peace Corps volunteers working there that there are no laws limiting access to prescription drugs by persons without a prescription.  Thus, people with no medical training can buy any prescription drug, along with needles and syringes to administer it without the intercession of a doctor.  Illiterate peasants living in remote villages know that penicillin and other antibiotics can cure infections that used to be fatal, and they frequently pool their resources to buy a supply to administer to sick villagers.  In order to save money, they often reuse needles and syringes.  AIDS in Honduras and other Central and South American third world countries has begun to spread throughout the population as a result of this practice.  

China

In china, the historical significance of opium and other narcotics is quite different than in the west.  In the nineteenth century, the British and other western nations intentionally used opium as a means of opening up the otherwise insular Chinese culture to trade.  (Internet search term; "opium wars" .)  As a result of this historical fact, the use of narcotic drugs is widely established among the peasant population as a whole in spite of the draconian methods that the Chinese government uses to suppress them (Mao Tse-Tung threatened to execute them if they didn't give up the habit).  In many poorer areas of China, large masses of the common people share needles and drug supplies thus spreading HIV very widely among the entire population (not just among isolated groups of drug abusers as in the US).

Even the public health establishment in China seems alien by western standards.  The Chinese have been ruled by legalistic, bureaucratic regimes for over a thousand years.  All bureaucracies (even in the US) tend to follow rigid, legalistic rules and guidelines which do not allow for swift, rational changes in procedure to cope with changing conditions (or even common sense circumstances).  The incidence of HIV has exploded in China over the course of a single decade.  The following quote is reprinted from The Times (of London).

 SATURDAY AUGUST 11 2001:

The blood bank system made the spread of HIV almost inevitable. Freshly drawn blood was collected in huge pools for the extraction of plasma, used in pharmaceuticals. Later, the mixed up blood was pumped back into the veins of the donors to allow a quick return to the blood bank. One woman said: “There are hundreds of thousands of people with Aids. It is a supercancer. We are just waiting to die.”

An especially good article that elaborates on these and other aspects of Chinese bureaucratic rule and the AIDS epidemic can be read by clicking here.

The general signs and symptoms of AIDS

HIV generally makes its presence known in two separate stages.  The first stage is called "Acute retroviral syndrome" and happens about two weeks after acquisition of the virus.  These symptoms are similar to those seen in a severe case of the flu or Mononucleosis (fever, malaise, sore throat, headache, cough, diarrhea, vomiting etc).  During this period, the virus is multiplying vigorously and a blood test will usually demonstrate the presence of HIV.  In many people, this stage will resolve spontaneously within two to three weeks, and if the patient has simply toughed out the illness without seeing a physician, he may not realize that he actually is infected with HIV.  

A long period (called a latency period) may elapse between this primary infection and the more serious secondary stage of the disease which has been labeled Acquired Immune Deficiency Syndrome, or AIDS for short.    The latency period is generally between 5 and 15 years, with the majority of patients developing AIDS at about eight to ten years, and about one percent not developing AIDS at all.   AIDS is characterized by secondary infections caused by organisms that take advantage of the patient's compromised immune response.   It is generally a combination of these "opportunistic infections" and the direct effects of HIV (the virus itself) which cause the two classes of signs and symptoms characteristic of the later stages of the disease and discussed below.

The Bangui definition of AIDS (The classic definition of AIDS)

1. Major signs

   • Unexplained weight loss greater than 10% of body mass

   • Fever lasting longer than a month

   • Chronic diarrhea of longer than one month duration

2. Minor signs

   • Persistent coughing

   • Itchy dermatitis (red, itchy skin, often with tiny pustules--pruritic dermatitis)

   • Recurrent Shingles (painful skin eruptions over the skin on one part of the body caused by the chickenpox virus, Herpes zoster.) 

   • Fungal infections  of the mouth and throat in younger persons not otherwise likely to get this disease.

   • Chronic, severe, recurring Herpes Simplex (similar to shingles but not confined to one part of the body)

   • Lymphadenopathy (generalized swelling of the lymph nodes, especially those of the head and neck)

The Bangui definition assumes that the presence of two of the major signs accompanied by one or more of the minor signs is an indication of severe suppression of the immune system, and in the third world may lead to the presumptive diagnosis of AIDS.  (There are actually about thirty signs of the disease, however those mentioned above are the most common.)  The Bangui definition was the primary means of diagnosis for HIV in the US and other Western countries prior to the introduction of serological (blood) tests that prove the existence of the virus in the body.  It is still used extensively in Africa to define AIDS and HIV, but it is no longer considered diagnostic in Western countries.  Even given a presumptive diagnosis of AIDS based on the Bangui definition, the presence of HIV cannot be assumed.  A blood test must confirm that the the virus is actually present. 

In the United states, the appearance of any disease characteristic of a severe immune deficiency in an otherwise healthy, young person is reason enough for the diagnosing doctor to recommend an HIV blood test. The discussion that follows involves the sorts of signs that might elicit such a recommendation from your dentist.

The oral signs of AIDS

If you have come here to look for images of lumps, bumps, sores or discolorations that you noticed in the mirror this morning, this is one of four pages with images you may find useful.  Read this page, Then proceed to three other pages on which you will find more images of both normal and abnormal oral structures and lesions  Normal oral anatomy Lumps, bumps and sores and discolorations Oral Cancer

 

Bear in mind throughout the following discussion that many of the disease entities shown here are not, in and of themselves, an indication of the presence of AIDS.  A few of them are "pathognomonic" which means that the presence of that symptom is considered indicative of the syndrome and should prompt the diagnosing practitioner to recommend a blood test to detect the presence or absence of HIV.  In such cases, this is clearly stated in the text.  In NO instance is the presence of any of the following conditions, in the absence of such testing, diagnostic of the presence of HIV.

Fungal Infections

Candidiasis (Thrush) Thrush is a common problem for infants since their immune systems are not yet fully developed. In healthy adults, however, it happens only rarely, and usually is an indication of a lowered immune response.  Often it is due to illnesses other than AIDS such as general viral infections or stress related fatigue.  It is characterized by creamy white, soft plaques that are easily scraped off the mucosa (the lining of the mouth) revealing a red, inflamed patch underneath.  This type is seen in the picture to the right.  It is easily treated with topical antibiotics like Nystatin. The image to the left shows pharyngeal candidiasis.  The pharynx is the throat, and pharyngeal candidiasis is an indication of the severe immune system depression characteristic of AIDS.  This form of yeast infection was considered pathognomonic of AIDS until it was realized that persons who use inhaled steroid medications for the treatment of asthma are also prone to this sort of infection.  (Once again, the presence of pathognomonic signs of a disease, --which means observable things that are frequently associated with a particular disease-- do not necessarily mean that the patient has that disease, but a blood test is strongly recommended in such cases.)   Oral and pharyngeal candidiasis are not contagious.

Angular Cheilitis Angular cheilitis is a very common fungal infection of the corners of the lips.  It happens all the time to healthy people who tend to have moist lips, especially in the cold winter months.  This condition is caused by a persistent fungal infection, and left untreated, tends to remain active for many months.  It generally looks like a reddened,  dry area at the corners of the lips.  The severe, white, ulcerated variety shown to the left is more indicative of the type seen in AIDS.  Even a severe case like this, by itself, does not indicate that the patient has AIDS.  It is easily treated with Nystatin cream which is simply an antibiotic that kills the fungus.  Angular cheilits is not contagious.  click the image on the left to see more images of angular cheilitis.

 

Viral associated signs of HIV Hairy Leukoplakia Hairy leukoplakia is one of the most common HIV  associated oral signs.  It is a white, corrugated or "hairy" "coating" on the lateral borders of the tongue.  Unlike Thrush, it is not easily scraped off.  It is painless, but patients occasionally complain of its appearance and texture.  It is caused by the body's reaction to the Epstein-Barr virus (responsible for Mononucleosis), and can be eliminated with a viral antibiotic like acyclovir (Zovirax®), famciclovir (Famvir®) or valacyclovir (Valtrex®).  This condition is rarely seen in patients not infected with  HIV.  However, some healthy patients may develop a "callous"  on the lateral borders of the tongue due to the nervous habit of continually scraping the tongue over the teeth.  This can lead to embarrassment if the dentist suggests an AIDS test to a person who believes such a suggestion is an insult!  It is never meant as a value judgment.  Hairy Leukoplakia is not contagious.  click the image to see a larger version of this image and more information on hairy leukoplakia.

Herpes Zoster (Shingles)

Herpes Zoster (better known as shingles) is caused by the same virus that causes Chicken Pox.    Herpes zoster "hides out" in a somatic nerve branch after the initial Chicken Pox infection (which usually happens in childhood), and flares up again later in life when the immune system begins to fail.  Shingles is common in otherwise healthy elderly persons.  It generally does not occur in younger people unless they are concurrently infected with the AIDS virus.  The distribution of the rash on the body is the key to the diagnosis of shingles, and distinguishes the herpes zoster virus from other forms of herpes viruses.  The distribution of the rash caused by herpes zoster in shingles is almost always on one side of the body, and is confined to the distribution of a single nerve root.  The skin surface distribution of each spinal or cranial nerve is called a dermatome.  The image on the left shows a rash which is confined to the dermatome defined by the third branch of the trigeminal nerve.  It is outlined in blue to make it easier to see.  Click the image to see larger images, as well as a great deal more on the concept of somatic dermatomes.  Shingles infections are quite painful, and they generally go away after four or five weeks, but shingles may reoccur again at a later date.  It frequently leaves those so afflicted with "postherpetic neuralgia" (PHN),  which is severely sensitive skin, well after the infection.  

Persons infected with HIV are prone to this disease if they have previously been infected with Chicken Pox.  For people with AIDS, this condition can be severe and even life threatening.  In the mouth, it is identified by its distribution. It is limited to one side of the affected organ.  The image to the right shows the Herpes zoster virus infecting half of the upper posterior palate.  It is easy to confuse Herpes zoster with Herpes simplex which may occur in the same distribution purely by chance.  While the Herpes simplex virus is contagious, Shingles, surprisingly is not.  Since a large percentage of the population already has been exposed to Chicken pox, most people harbor an immunity to Herpes zoster, and the probability that anyone will develop this disease depends more on the state of their immune system than on recent exposure to the virus.

 

Herpes Simplex (the "cold sore" or "fever blister" virus) Herpes Simplex (type I) is the virus that causes  cold sores in normal, healthy adults.  The image at the right shows a typical cold sore, sometimes called a fever blister due to its propensity to appear when the patient has a cold or other febrile (fever causing) illness.  This is another bug that, like Shingles, tends to "hang out" in a nerve root for  the life of the patient after the initial infection, which often occurs in childhood.  Once infected, the patient remains infected for life.  However the  virus remains dormant inside the nerve root most of the time until the patient suffers an illness or other problem which lowers his immune response.  The virus takes advantage of the drop in immune response to flare up in the typical cold sore seen in this image.  Click the image above for more on Herpes simplex. This image is what the initial infection may look like when a child, or young adult is first infected with the Herpes Simplex virus.  This is called "Primary Herpes stomatitis", and as you can see, it can look quite severe with blisters both inside and outside the mouth.  ("Stomatitis" means inflammation of the entire mouth.)  The patient is quite sick, but this primary infection will disappear after 10-14 days with rest and lots of fluids.  In healthy people, this infection happens only once in a lifetime.  The presence of the virus only becomes apparent in adulthood whenever a cold sore appears.   Whenever an adult appears in a clinic with a case of Primary Herpes Stomatitis, this infers a severely depressed immune response, and the dentist might consider referring the patient to a physician for diagnosis of an underlying disorder.  Adults presenting with severe herpes stomatitis should consider being tested for HIV.  It must be remembered, however, that a primary herpes stomatitis can happen at any time of life if the patient has never before had a cold sore.  Click on the image to see larger views of this condition.

Patients with AIDS have immune systems much more depressed than normal people with a cold or the flu.  AIDS victims may get not only recurrent cold sores, but recurrent (repeating) cases of full blown Herpes Stomatitis as well.  Whenever an adult appears in a clinic with a case of Primary Herpes Stomatitis, this infers a severely depressed immune response, and the treating physician or dentist may suspect an undiagnosed HIV infection underlying the Herpes infection. New antibiotics like acyclovir (Zovirax®), famciclovir (Famvir®) or valacyclovir (Valtrex®) are effective in suppressing the Herpes.  Herpes simplex blisters can sometimes occur in the oral cavity on tissues not generally associated with cold sores.  They always happen on tissue that is firmly bound down to underlying bone, such as the gums immediately around the teeth or on the roof of the mouth.  As you can see, the appearance of this infection in the mouth can easily be confused with Herpes Zoster (shingles), especially if it occurs on only one side of the mouth.  The viruses are closely related, and the blisters in the oral cavity can look identical.

The presence of this type of infection in the mouth does not indicate the presence of HIV, although this infection is more common in AIDS patients than in the non-HIV population.  This can happen to anyone who harbors the Herpes Simplex virus.  Left alone, provided the patient is not immunologically compromised, it disappears in 10 to 14 days and may be treated with acyclovir (Zovirax®), famciclovir (Famvir®) or valacyclovir (Valtrex®) for quicker recovery.  The herpes simplex virus is very contagious and if one person in a family develops a cold sore, then others in the family may develop one as well.  

A Note on Genital Herpes

Herpes Simplex type I (HSV-1) prefers to infect the face and oral cavity.  It is the virus most responsible for traditional cold sores and primary herpes stomatitis.  There is, however a second variety of Herpes that prefers to infect the genital areas.  Herpes Simplex Type II (HSV-2)  is called "genital Herpes" because of its venereal (sexually transmitted) qualities.  Both varieties produce similar lesions, the difference between them being their site specific preferences.  Both establish latency (take up permanent residence) in nerve roots and once established, tend to cause occasional outbreaks with active lesions (sores) in areas of the body serviced by that particular nerve root.   HSV-1 prefers to live in the trigeminal nerve root where it causes lesions in the oral cavity and on the face.  HSV-2 takes up residence in the sacral ganglion at the base of the spine where it may cause genital lesions (see the dermatome chart on the Herpes zoster page).

Even though each type has site specific preferences, the viruses are genetically similar and can take up residence in nerve roots in other parts of the body, including in each other's territory.  Outside of their own home territories, however, neither virus is especially virulent, and rarely cause recurrent outbreaks. 

HSV-2 causes approximately 90% of all cases of genital herpes.  Genital herpes caused by HSV-1 is generally much milder than that caused by HSV-2.   HSV-1 is usually transferred to the genital area by direct oral/genital contact, although the virus is present in the saliva of infected individuals.  Thus the use of saliva as a lubricant can, in fact, transfer HSV-1 to the genital area.  HSV-1 is found in only about 10% of all cases of genital herpes, however most people infected with HSV-1 in the genital area have few, if any, outbreaks after the initial episode.  HSV-2 prefers to live in this area and causes a much more virulent infection there. 

On the other hand, HSV-1 causes almost all cases of oral and facial herpes.  Oral herpes caused by HSV-2 almost never reoccurs, except in immunocompromised patients.

For more on this subject, visit this page.

Human Papillomavirus lesions (warts)

Warts are caused by a virus.  In the oral cavity, they tend to be somewhat flatter than the type occurring on hands, but if they are dried with air, the tiny projections characteristic of regular warts become evident.  The causitive agent is the Human Papillomavirus (HPV).  These growths generally are not painful and can be ignored unless they interfere with appearance or function.  Persons infected with HIV may develop very large, multiple warts.  They may be removed using lasers, cautery or cold steel blades.  The presence of oral warts is not in itself an indication of AIDS.  HPV is contagious.

Neoplasms (tumors, or "growths")

Kaposi's Sarcoma (KS) (pronounced "cap-o-zeez")

Kaposi's Sarcoma is a tumor composed  of numerous tiny blood vessels.  It tends to be dark red or deep purple.  It may be flat, or a swollen mass.  These growths are not generally painful unless secondarily infected by another type of Herpes or bacteria.  Thus good oral hygiene is important in the management of these tumors.  Kaposi's occurs most frequently on the skin,  although tumors can occur in the gastrointestinal tract and mouth.  In the oral cavity, the lesions occur mostly on the palate (the roof of the mouth).  Although they are technically a form of cancer, there is evidence that they are, in fact the result of a secondary infection with Herpes virus type VIII.  This virus is found in high concentration in the saliva of infected individuals and can cause Kaposi's Sarcoma only in patients with very compromised immune systems.  Some recent research has shown that this virus is transferred through deep kissing.

Kaposi's tumors are seen almost exclusively in gay men with AIDS.  The occurrence of one of these lesions anywhere on the body of a young man is indicative of the presence of HIV. Kaposi's is infrequent in women, even women with AIDS.  It is also rare in men who have contracted AIDS via intravenous drug use.  It is not known why women and heterosexual males with AIDS do not generally succumb to Kaposi's sarcoma, although there is probably an association between the gay lifestyle and the transfer of the herpes type 8 virus. These lesions occur as the initial manifestation of AIDS in approximately 11% of patients.  Prior to the AIDS epidemic, they were seen (rarely) only on the lower extremities of elderly men.

 

Lymphoma (lymphatic cancer)   Non Hodgkin's Lymphoma (NHL) is a cancer that starts in a lymph node and  spreads to other areas of the body through the lymphatic system and the blood vessels.  Prior to the AIDS epidemic, NHL generally effected older individuals (average age 67), however the incidence of NHL has increased substantially in younger persons since the beginning of the AIDS epidemic.  Lesions (abnormalities) like those in the image to the right, especially in a younger person, may be the first indication that a patient has HIV, although it is usually accompanied by a generalized lymphadenopathy (swelling of lymph nodes all over the body).  A suppressed immune response is a strong factor in the development of NHL, however persons with no history of immunosuppression (or HIV)  may contract the  disease.  There is some evidence that one or more secondary viruses may bear the responsibility for the actual disease, the Epstein-Barr (Mononucleosis) virus once again being a prime suspect.  Treatment for this condition usually involves chemotherapy and Radiation therapy

Bacterial diseases associated with AIDS

Periodontal Disease  In order to understand how periodontal disease  (gum disease) affects persons with AIDS, it will be helpful to read my explanation of regular periodontal disease, since the process in HIV infected people is the same (albeit mo