HIV-associated salivary disease is a relatively benign condition. Dry mouth, dry eyes and enlarged parotid glands (the glands in front of the ears that swell during mumps) are symptoms of salivary gland dysfunction. Swollen glands, also known as parotitis, are the result of cysts and lesions in the salivary gland tissue.

There are a number of theories about the cause of this condition. Some research has suggested that salivary tissue lesions are a manifestation of swollen lymph glands that can affect people with HIV, known as persistent generalised lymphadenopathy (PGL). Cysts are thought to occur when lymph fluid or tissue seeps into the glands.

Other research has found evidence of a connection between salivary dysfunction and CMV.

Cysts and lesions are usually benign; however malignant lymphoma may occur.

Incidence

HIV-associated salivary disease may occur early in HIV disease when CD4 levels are within the normal range. Symptoms may be an early sign of HIV disease progression. A person with swollen salivary glands and dry mouth whose HIV status is unknown may be advised to consider HIV testing.

This condition commonly occurs in children. A survey of 50 children with AIDS found that about 20% had HIV-associated salivary disease.

Treatment

Medical therapy using anti-HIV drugs including protease inhibitors, anti-inflammatory medications called corticosteroids. and withdrawal of fluid from cysts have all been reported as effective in reducing the size of swollen parotid glands. Large cysts may be removed surgically.

Symptoms such as dry mouth can be relieved by drinking more water and chewing sugar-free gum.

References

Craven DE et al. Response of lymphoepithelial parotid cysts to antiretroviral treatment in HIV-infected adults. Annals of Internal Medicine 128(6):455-459, 1998.

DiGiuseppe JA et al. Lymphoid infiltrates of the salivary glands: pathology, biology and clinical significance. Current Opinions in Oncology 8(3):232-237, 1996.

Greenberg MS et al. Relationship of cytomegalovirus to salivary gland dysfunction in HIV-infected patients. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 83(3):334-339, 1997.

Greenspan D et al. Oral manifestations of HIV infection. AIDS Clinical Care 9(4):29-33, 1997.

Maiorano E et al Lymphoepithelial cysts of salivary glands: an immunohistochemical study of HIV-related and HIV-unrelated lesions. Human Pathology 29(3):260-265, 1998.

Schmidt Westhausen A et al. HIV-associated salivary gland diseases. Review of the literature and 3 case reports. Mund Kiefer Gesichtschir 1(2):82-85, 1997 (abstract in English).