Several fungal and viral infections can affect the mouth in people with HIV.

Causes

Faint red patches, often on the palate, may be an early sign of Candida. Candida can also cause white patches anywhere inside the mouth. If it affects the corners of the lips they become red or cracked this is called angular cheilitis. Rarely, other fungal infections can cause oral ulcers.

Kaposis sarcoma can also occur on the palate or gums, causing a purple patch which, if raised or ulcerated, may create problems with eating and speaking or cause pain.

A white ridged patch, usually on the sides or undersurface of the tongue, is a sign of hairy leukoplakia. It is now known that hairy leukoplakia is caused by the Epstein-Barr Virus, the virus associated with glandular fever and cancer of the lymph nodes called lymphoma. In addition, firm and persistent oral lesions may be the first sign of lymphoma.

Many people get cold sores, small blister-like lesions on the edge of the lip caused by the herpes simplex virus. In people with HIV these can be more severe, and herpes simplex can also cause ulcers. Herpes zoster, the virus which causes chicken pox, may also cause oral lesions which rupture and form ulcers. Another member of the herpesvirus family, CMV, can also cause oral ulcers.

Immune suppressed individuals may also develop oral warts which are caused by the human papilloma virus (HPV), a virus more typically associated with genital warts and cervical cancer. Oral warts are still seen frequently in people taking protease inhibitor treatment. Some clinicians believe that outbreaks of oral warts may be caused by immune reconstitution after starting combination therapy, and that they are a sign that the immune system is becoming more effective at recognising and attacking the human papilloma virus.

It is rare for Candida, leukoplakia, and warts to appear at the same time, leading to speculation that both systemic and local immunity play a part in fighting Candida and leukoplakia, whereas oral warts are associated with factors other than local, mucosal immune function.

What to do

The prevalence of oral lesions and infections among people with HIV has fallen since the introduction of highly active antiretroviral therapy. If you are not already taking anti-HIV drugs, you might consider this treatment option to strengthen your immune system and prevent recurrence of oral lesions.

Alternatively, you may decide to treat the specific infection in the absence of antiretroviral therapy. Candida infections can be treated with anti-fungal lozenges, mouthwashes or pills.

Kaposis sarcoma in the mouth may be treated locally with radiation therapy, or may respond to systemic chemotherapy; if the lesions are ulcerated, antibiotics may be required. Hairy leukoplakia is normally not treated, but if it is extensive or painful high doses of acyclovir may be tried. Lesions often return at the end of treatment in the absence of antiretroviral therapy.

Mild herpes simplex infections may be treated with acyclovir ointment, or tablets if it is more serious. Similarly for lesions caused by herpes zoster - acyclovir or famciclovir may be taken orally for seven to ten days.

Oral warts caused by HPV may be cut out using surgery or a laser. However, these warts often recur and cutting the wart, which causes bleeding, may cause the wart virus to spread within the mouth. Unless the warts are becoming much larger, or spreading, it may be preferable to wait and see if they go away after six months or so.

For more details, see specific entries in Symptoms and illnesses: A to Z of illnesses.