Effects of highly active antiretroviral therapy on HIV-1-associated oral complications

The oral cavity of human immunodeficiency virus type I (HIV-1) infected individuals is subjected to a series of opportunistic infections which are usually considered as a prognostic marker for the severity of infection as well as an indicator of immunodeficiency. The highly active antiretroviral therapy (HAART) has significantly lessened the severity of HIV-associated oral infections although this therapeutic regimen is considered to be responsible for some of the oral lesions such as oral warts and salivary gland disorders. In addition, the beneficial effects of HAART on HIV associated oral lesions are stratified with age, with the adult population showing improvements whereas the oral lesions among children remain unchanged with this therapy. The presence of HIV-1 in the saliva, and infectivity of oral epithelial cells suggest that the oral cavity is a site of HIV pathogenesis and potential reservoir for the disease in the setting of virally suppressive HAART. Overall HIV associated oral lesions are usually due to fungal, bacterial, and viral infections as well as some of unknown etiology. This review describes the current status of HIV associated oral lesions by comparing historically available pre-HAART data. Future directions envisioned by the National Institutes of Health as well as novel avenues to be explored are also presented.