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Virus

Human immunodeficiency virus infection, AIDS and infections in compromised


patients

Introduction

The first human retrovirus is human T- lymphotropic virus type I (HTLV) was
isolated from a patient with T-cell leukaemia. In recent years it has become
clear that another retrovirus , human immunodeficiency virus (HIV) , is
responsible for acquired immune deficiency syndrome (AIDS) and has impact
on dentistry . There are number of oral manifestions of HIV infections , some of
which may be presenting features of the disease and to which dentist must be
alert.

To conquere HIV infection and AIDS are consuming million dollar and thus for
all effort at producing a preventive vaccine have failed

General properties of retroviruses

Group of RNA viruses. : Contain of enzyme reverse transcriptase, which is an


RNA dependent DNA polymerase. All retroviruses have an envelope composed
of lipid and viral proteins. Diameter viral particle is about 100nm.
Replication: Retrovirus is different from other DNA viruses, since they replicate
and produce viral RNA from DNA copy of the virion RNA through the action of
reversetranscriptase

HIV and AIDS transmission: In developed countries, homosexual men has been
the most at risk of HIV infection, intravenous drug user. Sexual transmission is
primarilary from male to male or male to female. In Africa heterosexual
transmission is a common event, mainly young adult. Vertical transmission to
infants from infected motherand may occur in utero, either perinatally or
postnatally.

HIV transmission: inoculation of blood transfusion of blood and blood


product, needle sharing by intravenous drug user, needlr stick accident

Sexual transmission: male homosexuals, heterosexual contact

Perinatal transmission: intrauterine, peripartum, breast milk.

Clinical Features of AIDS Lymphadenopahy and fever (accompanied by


weight loss and malaise

Opportunistic infections ( pneumocytis carinii


pneumonia,Cerebral toxoplasmosis,Cryptococcal
meningitis,Candidosis,herpes virus
infections,Diarrhoeal disease
Mlignancies (Kaposi sarcoma,Non Hodgkins
Lymphoma
AIDS related dementia(Decrease in cognitive
and/or motor functions

Pathogenesis: The main determinant the pathogenesis and the disease cause
by HIV is the tropism of this virus for CD4cells namely the helper and delayed
type hypersensitivity T cells. After infected CD4 the virus replicated and
established latency. Activation of the infected CD4 T cellsat a later date, for
example by contact with a forein antigen, was then belived to result in viral
killing of the cells . Recent evidence indicates that HIV destroy many cells of
immune system.

Key to stages in replicative cycle.

1. HIV releases contens into target cells


2. Reverse transcriptase copies viral RNA into DNA
3. Viral DNA insertec into celluler DNA
4. Many copies of viral RNA and protein are made
5. New viral particle assemble, potentially killing it

Oral lesions strongly associated with HIV Infection

1.Candidosis : erythematous is very common feature of HIV infections appears


as red areas , found in hard and soft palate ,buccal mucous and tonque

pseudomembranous present as white creamy plaque,cheilitis

2. Oral Hairyleukoplakia is an asymptomatic, white, hyperkeratotic lesion,


presenting on the lateral or marginal tonque
3. Kaposi,s sarcoma arise from endothelial cells of blood vessel , present as
purple/dark blue macula or nodule most commonly on tha palate. Common in
homosexcual patients

4.Non Hodgkins Lymphoma appears as a rapidly growing swelling or intractable


ulceration, with may occurs anywhere in mouth

5. Periodontal disesase: linear gingival erythema present as localized


red band on the marginal gingival

necrotizing ulcerative gingivitis involved localized


ulcerative destrutionof the gingival with pain and spontaneous gingival
bleeding

necrotizing ulcerative periodontitis is rapid,localized


ulcerative destruction of periodontal tissue, including bone

6.Other oral lesion seen in HIV infection include recurrent intraoral herpes
simplex infections, cytomegalovirus associated oral ulceration and paretic
gland enlargement, the latter in association with oral dryness

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