HIV/AIDS is currently the leading cause of death in Africa and the fourth leading
cause of death worldwide. This systematic review of the literature was conducted to
evaluate the evidence for treatment of the most common oral lesions associated with
HIV: oral candidiasis with or without oropharyngeal involvement (OPC), oral hairy
leukoplakia (OHL), recurrent aphthous-like ulcerations (RAU), oral Kaposi’s sarcoma
(OKS), orolabial herpes simplex infection (HSV), oral herpes zoster infection (VZV),
intraoral or perioral warts (HPV), and HIV-associated periodontal diseases. Treatment
of HIV-associated salivary gland disease is addressed in a different section of this
World Workshop. We found the largest body of evidence for treatment of OPC in HIV
patients. Future trials will be needed to test drugs currently in development for
treatment of Candida strains that are resistant to existing therapies. There were no double blind, placebo-controlled
randomized clinical trials (RCT) for topical treatment of OHL, and only one RCT for
systemic treatment of the lesion with desciclovir. Systemic thalidomide was the only
drug tested in RCT for treatment or prevention of RAU. Only 1 double-blind RCT comparing
vinblastine and sodium tetradecyl sulfate was identified for localized treatment of
OKS. Three drugs (famciclovir, acyclovir, and valaciclovir) were shown to be effective
in randomized, double-blind trials for treatment or suppression of mucocutaneous HSV
lesions in HIV patients. In all 3 trials, the effects of these medications on orolabial
HSV lesions were not reported separately. There were no double-blind, placebo-controlled
RCT testing topical treatments for orolabial HSV lesions in HIV patients. No trials
testing treatments of oral VZV were identified. There were no double-blind, placebo-controlled
RCT for treatment of HIV-associated intraoral or perioral warts or periodontal diseases.
In conclusion, there is a need for well-designed RCTs to assess the safety and efficacy
of topical and systemic treatments of most oral mucosal and perioral lesions in HIV
patients. There is also a need to develop newer drugs for treatment of resistant fungal
and viral microorganisms. Finally, standardized outcome measures should be developed
for future clinical trials to allow comparisons of studies using different populations.
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Article info
Publication history
Accepted:
November 1,
2006
Received:
November 1,
2006
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
