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ORAL CHANGES IN CHILDREN WITH AIDS
Isaeva Mukaddaskhon Muhammedovna
Assistant of the Department of Children's Dentistry ASMI
Abstract.
Pediatric AIDS is associated with a broad spectrum of systemic complications,
among which oral manifestations play a crucial diagnostic and prognostic role. This article
examines the prevalence, types, and clinical relevance of oral changes observed in children
with AIDS. Common conditions include candidiasis, linear gingival erythema, oral hairy
leukoplakia, and herpetic lesions. These manifestations often reflect the degree of
immunosuppression and may serve as early indicators of disease progression or
antiretroviral therapy failure. Emphasis is placed on the need for interdisciplinary
management, early diagnosis through routine oral screening, and the integration of dental
care into pediatric HIV treatment protocols.
Kеywоrds:
pediatric AIDS, oral manifestations, HIV-related lesions, oral candidiasis,
immunosuppression, dental care, opportunistic infections.
INTRОDUСTIОN
Human Immunodeficiency Virus (HIV) infection in children leads to Acquired
Immunodeficiency Syndrome (AIDS), a condition characterized by profound
immunosuppression and multisystem involvement. The oral cavity is often one of the first
sites to reflect the systemic deterioration associated with HIV, especially in pediatric
patients whose immune systems are still developing. Oral lesions can affect nutrition, speech,
psychological well-being, and overall quality of life, making their recognition vital for early
intervention.
Children with AIDS are more prone to opportunistic infections, and due to differences in
immunity and disease progression compared to adults, the pattern of oral changes may be
unique. The presence, type, and severity of these lesions can provide insights into the
patient's immunological status and therapeutic response, thereby supporting clinical
decision-making.
MАTЕRIАLS АND MЕTHОDS
The occurrence of oral lesions often parallels the progression of AIDS and serves as a
clinical marker for immunologic decline. For example, candidiasis may precede serological
markers of HIV progression, making it an early warning sign. Moreover, certain lesions,
such as LGE and OHL, are considered AIDS-defining conditions under WHO staging
criteria for pediatric HIV [1].
RЕSULTS АND DISСUSSIОN
Management of oral manifestations requires coordinated care among pediatricians,
infectious disease specialists, and dental professionals. Antiretroviral therapy (ART) plays a
central role in lesion resolution; however, local antifungal or antiviral treatments are often
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necessary. Preventive dental care, oral hygiene education, and nutritional support are equally
important in mitigating the impact of oral diseases in HIV-positive children.
The oral manifestations observed in HIV-positive children are largely attributable to
progressive immune system impairment, particularly involving CD4+ T-lymphocyte
depletion and altered cytokine signaling. In pediatric patients, whose immunological
defenses are still maturing, the viral load tends to be higher and immune dysregulation more
pronounced than in adults. This immunopathological backdrop renders the oral mucosa
highly susceptible to colonization by opportunistic fungi, viruses, and bacterial pathogens.
The mucosal epithelium, serving as a primary barrier, becomes compromised due to HIV-
associated reductions in salivary immunoglobulins (especially IgA) and antimicrobial
peptides such as histatins and defensins. These deficits reduce resistance to microbial
invasion, allowing even low-pathogenic flora to induce overt pathology. Furthermore,
impaired neutrophil and macrophage function disrupts local immune responses, promoting
chronicity and recurrence of oral lesions [2].
Oral pathology in children with AIDS frequently compromises mastication, swallowing, and
overall oral intake. Painful ulcerations, mucosal inflammation, or candidiasis can lead to
reduced appetite and selective feeding behavior, thereby contributing to malnutrition.
Moreover, recurrent infections often result in systemic catabolism and impaired nutrient
absorption [3].
Longitudinal studies have established a strong correlation between chronic oral infections
and growth faltering in HIV-positive pediatric populations. In resource-limited settings, this
impact is magnified by food insecurity, delayed diagnosis, and limited access to therapeutic
dental services. Thus, oral health should be prioritized not only for its local effects but also
for its role in maintaining systemic nutritional status and supporting developmental
outcomes.
Beyond their physiological consequences, oral lesions exert a considerable psychosocial
burden on HIV-infected children. Painful, visible, or malodorous oral conditions can lead to
embarrassment, social withdrawal, and bullying — particularly in school-aged children.
Adolescents may experience self-image disturbances, further exacerbated by stigma
associated with HIV.
Such psychosocial factors can hinder adherence to ART regimens and undermine overall
disease management. Integrating psychological support into oral health services is therefore
crucial, including age-appropriate counseling, caregiver education, and school-based
awareness programs to reduce stigma and promote inclusivity [4].
Providing oral healthcare to children with AIDS involves a number of clinical and ethical
complexities. These patients often present with multiple concurrent oral pathologies, delayed
wound healing, and higher susceptibility to superinfections. Moreover, their general medical
condition, nutritional status, and immune profile must be considered prior to any invasive
dental intervention.
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One of the key clinical challenges lies in the increased risk of bleeding and infection during
dental procedures, especially in children with thrombocytopenia or neutropenia —
conditions not uncommon in advanced HIV stages or as side effects of long-term
antiretroviral therapy. Routine procedures such as tooth extractions or periodontal
debridement must be preceded by hematological assessments and may require prophylactic
antibiotics or adjunctive therapy.
СОNСLUSIОN
Oral changes in children with AIDS are not merely local phenomena but reflect systemic
immunosuppression and disease trajectory. Their presence necessitates early detection,
multidisciplinary management, and inclusion in routine pediatric HIV care protocols. As
survival rates improve with ART, maintaining oral health becomes essential for enhancing
quality of life and minimizing morbidity in this vulnerable population.
RЕFЕRЕNСЕS:
1.
Lauritano, D., Moreo, G., Oberti, L., Lucchese, A., Di Stasio, D., Conese, M., &
Carinci, F. (2020). Oral manifestations in HIV-positive children: A systematic review.
Pathogens, 9(2), 88.
https://doi.org/10.3390/pathogens9020088PubMed
2.
Barasch, A., Safford, M. M., & Catalanotto, F. A. (2000). Oral soft tissue
manifestations in HIV-positive vs. HIV-negative children: A longitudinal study. Pediatric
Dentistry,
22(3),
215–220.
https://www.aapd.org/globalassets/media/publications/archives/barasch-22-
3.
Chigurupati, R., & Turner, M. (1996). Pediatric HIV infection and its oral
manifestations.
Pediatric
Dentistry,
18(2),
106–109.
https://www.aapd.org/globalassets/media/publications/archives/chigurupati-18-
4.
Shetty, K. (2006). Oral lesions and paediatric HIV. British Dental Journal, 201(11),
555.
