Many children with HIV have oral manifestations of the infection (Table 21.1), including some that are part of the 1994 CDC classification system [1]. Since the introduction of antiretroviral therapy and highly active antiretroviral therapy (ART and HAART), the prevalence of these oral manifestations has decreased. However, in many countries where therapy is less than ideal, such as Romania, Brazil, and Mexico, HIV-associated oral lesions are more common, with prevolenic ranging from 55%–61% [2–4]. Their presence can still be used as markers for progression of disease. Referral to a dentist before 1 year of age is recommended for all children, but this is especially important for the HIV-infected child. Careful examination of the soft tissues and teeth is essential.

Oral mucosal lesions

Fungal infections

Oral candidiasis (thrush) is by far the most common oral opportunistic infection in HIV-infected children [5–8]. Prevalence estimates in this group range from 28%–67% (Table 21.1), and its presence is associated with low or declining CD4 counts [7, 8]. The diagnosis and treatment of Candida infections are discussed in detail in Chapter 33.

Oral candidal infections can appear as a red patch (erythematous, Fig. 21.1), a white patch that rubs off (pseudomembranous) or as red patches at the corners of the mouth (angular chelitis). Often, patients are asymptomatic, but they may experience oral burning or soreness. The diagnosis of oral candidiasis is based on clinical appearance and the presence of hyphae on a smear prepared with potassium hydroxide.