Painful gingivitis may be an early sign of infection with the human immunodeficiency virus

Anecdotal reports have suggested that painful gingivitis may be associated with infection due to the human immunodeficiency virus (HIV). Twenty patients who presented to the emergency department with a chief complaint of gum pain were evaluated for HIV infection, CD4/CD8 T lymphocyte profiles, complete blood cell counts and differentials, and lymphocyte function (response to mitogenic stimulation). Seven of the 20 patients (35%) were seropositive for HIV. Three of the seven HIV-seropositive patients were unaware of their HIV infection until tested in this study (with use of an ELISA and western blotting). The HIV-seropositive patients were significantly older than the HIV-seronegative patients (31.4 +/- 3 years and 24 +/- 1 year, respectively). Two of the seven HIV-seropositive patients presented with severe CD4 lymphocyte depletion. The other five HIV-seropositive patients presented with CD4 lymphocyte counts of 473 +/- 155 (mean +/- SE). Regardless of HIV serological status, all patients demonstrated a severely depressed mitogenic response when compared with control subjects. There were no remarkable differences in complete blood cell counts and differentials within each serological group. Significant differences, however, were noted when CD4/CD8 lymphocyte counts and ratios were measured. Identification of clinical presentations, such as painful gingivitis, that reflect an early stage of HIV infection could aid in the timing of therapy and prevention of the spread of HIV infection.