HIV and the mouth

January 2007     View PDF     En español

Viral infections

Mouth conditions caused by viruses can be painful and are rarely fully cleared from a person’s body. There is, however, effective therapy that can treat current conditions and suppress future outbreaks.

Herpes simplex
Herpes simplex virus (HSV) Type 1, which causes blisters on the lips, is fairly common in the general population and even more so in people living with HIV. In addition to sores on the lips, HSV-1 can appear inside the mouth, as “bubbles” on the gums and in the mouth, often in firmer tissue, like the roof of the mouth. Herpes sometimes appears on the back or sides of the tongue or cheeks. Herpes sores can occur with fever, pain and loss of appetite. They can either be small and almost painless or they can be troublesome, extensive and persistent. Often, they’re left untreated because they clear up after a relatively short period of time. Sores that are slow to heal can be treated with 1,000–1,600mg Zovirax (acyclovir) daily for seven to ten days. For more information, read the publication, Oral and Genital Herpes.

Herpes Zoster
Herpes zoster (Varicella zoster virus, or VZV) is a reactivation of the same virus that causes chicken pox. Outbreaks produce sores on the skin or in the mouth. The sores begin as “bubbles” and then break and crust over. Oral lesions also begin as “bubbles”, but they later burst to form ulcers or open sores. Treatment should be started as soon as possible and involves using 500mg oral Famvir (famciclovir) every eight hours for seven days or 800mg oral acyclovir five times a day for 7–10 days.

Hairy leukoplakia
Oral hairy leukoplakia (OHL), believed to be caused by the same virus (Epstein-Barr virus) that causes mononucleosis (mono), is one of the most common HIV-related oral conditions. It’s not dangerous and can occur very early in HIV disease. It may, however, point to an increasing risk of other, more serious illnesses.

Symptoms include white patches on the sides of the tongue or walls of the mouth. They look corrugated, or folded, with hair-like particles along the folds. OHL is rarely (if ever) painful and while annoying (people complain about its appearance and texture), it’s not serious.

Hairy leukoplakia can be treated with 2.5–3mg acyclovir once a day for 2–3 weeks. It has also been reported that Cytovene (ganciclovir), Retin-A (tretinoin) and Podocon-25 (podophyllin) can be effective. For those interested in alternative therapies, propolis tincture (a product of bees) has shown some favorable results when applied directly to the lesions. Unfortunately, all these treatments must be taken continuously because lesions return when treatment is stopped. There’s some evidence that acyclovir may suppress breakouts, but other evidence suggest that it’s ineffective in treating this condition.

Cytomegalovirus
Cytomegalovirus (CMV) mostly occurs in people with late-stage disease, and only very rarely does it manifest in the mouth. Some dentists, however, report that they find CMV in ulcers on the inner lining of the mouth in people with CMV disease. These sores can be widespread and have been seen on the gums, cheeks and roof of the mouth. Since oral CMV ulcers can look like other ulcers, a biopsy may be necessary to identify it in the mouth. When ganciclovir (in the vein, followed by oral drug) is used to treat CMV disease, the oral ulcers recede.

Human papillomavirus
Human papillomavirus (HPV) is the same virus that causes genital and anal warts. In people living with HIV, HPV lesions can begin to appear on the skin and inner lining of the mouth. In the mouth, they look like typical warts: cauliflower-like, “spiky” or slightly raised with a flat surface. It’s not currently thought that oral warts can become cancerous. Surgical or laser removal is the most effective way to treat them. However, recurrence is common, so removal should probably be reserved for lesions that interfere with overall appearance or normal activities like chewing, swallowing or talking. Be aware that if you have HPV, safe oral sexual practices are necessary to prevent passing it on to your partner.