RESUMO

A epidemia de HIV/AIDS, que sofreu grandes mudanças em seus padrões clínicos e epidemiológicos, atingiu neste século sua estabilidade. Durante estes 30 anos os profissionais de saúde aprenderam muito sobre a doença e hoje esse aprendizado reflete-se em maior eficiência no diagnóstico e no tratamento da infecção pelo vírus e de suas manifestações oportunistas. As lesões orais associadas ao HIV são motivo de estudo desde os primeiros relatos da doença no início dos anos 80, e foram relacionadas ao sexo, idade, naturalidade, forma de exposição ao vírus e a padrões virológicos e imunológicos. Mas a pressão exercida pelas mudanças das características demográficas da epidemia sobre as manifestações bucais oportunistas do HIV não foi levada em consideração. A estabilidade da epidemia e o amadurecimento do conhecimento proporcionam um terreno propício para a avaliação da real prevalência dessas manifestações. Esta pesquisa tem como objetivo verificar como está este panorama no Brasil. Cento e quatro pacientes HIV+ em início de TARV foram avaliados clinicamente, e foram colhidos dados demográficos e exames laboratoriais, além da execução de sialometria e índice CPO-D. A população avaliada foi predominantemente masculina (78,8%) com média de 37,8 anos de idade. A via de transmissão do HIV foi sexual, sendo 57,7% através do sexo homo/bissexual e 38,4% com sexo heterossexual. 52,9 % souberam de sua soropositividade a menos de um ano

O CD4 médio foi de 223 céls/mm³ e a CV de 121.400 cópias/ml. As lesões extraorais foram diagnosticadas em 10,6% dos pacientes, sendo as hiperpigmentações de pele e mucosa (9,6%) e o aumento de glândulas salivares (0,96%) as lesões mais encontradas. A candidíase oral (49%) e a leucoplasia pilosa (41,3%) foram as lesões intraorais mais prevalentes. A xerostomia foi queixa de 46,6% e a hipossalivação foi diagnosticada em 18% e 48% dos pacientes, dependendo da metodologia utilizada para avaliação. O índice CPOD foi de 14,4, considerado alto pela OMS. A presença de lesões orais, candidíase e leucoplasia pilosa foram associadas à baixa imunidade e a presença de lesões orais e candidíase a cargas virais altas. A hipossalivação, avaliada através do fluxo salivar estimulado e representando principalmente a saliva da parótida, foi relacionado com níveis de CD8 alterados. Comparado com a literatura revisada, a prevalência de lesões orais associadas ao HIV apresenta-se alterada neste estudo, principalmente pela ausência de diagnóstico de neoplasias malignas e baixa prevalência de outras lesões orais associadas à aids.

HIV/AIDS epidemic, which has undergone major changes in their clinical and epidemiological patterns, in this century reached its stability. During these 30 years, much has been learned about the disease by health care professionals and nowadays, all this knowledge is reflected in greater efficiency in the diagnosis and treatment of virus infection and its opportunistic manifestations. HIV oral related lesions have been studied since the first reports of the disease in the earlies 80's, and were related to gender, age, place of birth, route of virus exposure, and virological and imunological patterns. Demographic changes of the disease over oral HIV opportunistic diseases have not been taken into consideration. The stability of epidemics and maturing of knowledge provide a fertile ground for the evaluation of the real prevalence of these manifestations. This research aims to verify this scenario in Brazil. A hundred and four HIV+ patients starting HAART were evaluated clinically, and demographic data and laboratory tests were collected, in addition to performing sialometry and DMFT index. The population was predominantly male (78,8%), average of 37,8 years old. The route of HIV transmission was sexual, 57,7% through homo/bisexual sex, and heterosexual sex, with 38,4%. 52,9% knew their HIV sero status to less than one year

The average CD4 was 223 cell/mm3 and CV of 121,400 copies/ml. Extra oral lesions were observed in 10,6% of patients, the skin and mucosal hyperpigmentation (9,6%) and enlargement of salivary glands (0,96%) were the lesions diagnosed. Oral candidiasis (49%) and oral hairy leukoplakia (41,3%) were the most prevalent intraoral lesions. Xerostomia was a complaining of 46,6% and hyposalivation was diagnosed in 18% and 48% of patients, depending on the methodology applied. The DMFT index was 14,4, considered high by WHO. Oral lesions, oral candidiasis and oral hairy leukoplakia were associated to low immunity and high viral load levels. Hyposalivation, evaluated by stimulated salivary flow (mainly, representing the saliva produced by parotid gland) was associated with altered levels of CD8. Compared to reviewed literature, oral lesions prevalence was considered altered in this research, notably the lack of diagnosis of malignant neoplasias and low prevalence of other lesions associated with aids

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RESUMO

The incidence of oral manifestations of HIV infection is changing markedly. Oral afflictions previously uncommon in HIV condition are now emerging in this scenario and may be underestimated. Clinical characteristics of some oral diseases could change in the presence of HIV/AIDS infection and health care professionals must be made aware of such changes. Oral lesions of secondary syphilis are rare, however they can occur and the dentist should be able to diagnose them. In some cases the anamnesis and the clinical features of the lesions are not enough to diagnose this disease. Histological features and an acute knowledge on laboratory exams, as well as its applicability and limitations are necessary to diagnose it. The present report describes a case of secondary syphilis in an HIV positive patient. The patient showed red spots in the torso of skin and abdomen. The spots were also present on the hands but the color was darker. The oral mucosa had several ulcers, with variable shapes, sometimes recovered by a white and resistant membrane. They were present in the buccal mucosa, palate, gingiva, tongue and labial mucosa. Those clinical manifestations appeared 6 months earlier. Exams were performed (VDRL, FTA-abs, direct fungal exams in the skin and oral mucosa and a biopsy in the oral mucosa) but the diagnose remained unclear. Clinical and laboratory features disagreed and postponed the final diagnosis and the treatment for more than 6 months.

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