HIV/AIDS: Etiology and Oral Manifestations

People may become infected with HIV if they engage in specific behaviors that put them at risk, or if they are exposed through needlestick injuries (usually in a dental care setting). Other blood contact with mucous membranes or non-intact skin provides a possible, but not probable, chance of transmission.

HIV is transmitted through:

Unprotected anal, vaginal or oral intercourse;
Sharing needles or other injection equipment;
A mother passing the virus to her baby either before or during birth;
An infected woman breastfeeding her infant;
Transfusion of HIV-infected blood or blood products (prior to 1986);
Accidental needlestick injuries, or infected body fluid coming into contact with the broken skin or mucous membranes of another person (as with healthcare workers);
Sharing razors or toothbrushes, if infected blood from one person is deposited on the toothbrush or razor, and the blood enters the bloodstream of another person.

The transmission of HIV depends upon:

The availability of the infectious agent in sufficient quantity;
The viability of the infectious agent (how strong it is);
The virulence of the infectious agent (how infectious it is);
The ability of the infectious agent to reach the blood stream, mucous membranes; or broken skin of a potential host (i.e., getting into another person's body).

Case Study #2

Ms. H. is a 20-year-old African American female. She has been sexually active since she was 15, and has been treated several times in the past for sexually transmitted diseases (STDs). She recently presented to the STD clinic with c/o painful open sores on her vaginal area. She had several partners in the past two months, but she did not see any similar sores on any of them. The provider told Ms. H that it is important to use barriers when having sex to prevent STDs and also HIV. She explained that it increases the possibility of infection when someone has a break in his or her skin or mucous membranes, allowing the virus to pass more easily from one person to another. She also explained that, while most STDs can be treated, HIV has no cure. Ms. H. agreed to be tested for HIV as well as STDs. Unfortunately, her test results showed that she had genital herpes, but was negative for HIV. Her provider reminded her that she could have future outbreaks of herpes that would leave her vulnerable to infection with HIV because of the open areas on her skin. She was provided with both male and female condoms before leaving the clinic, and encouraged to tell her partners about the herpes before having sex.

One of the predictors of how infectious an HIV-positive person may be, is their viral load, which indicates how much HIV is present in the bloodstream. Studies show a clear connection between higher viral load in the blood and increased transmissibility of HIV.

Testing for HIV began in 1985 has almost completely eliminated these risks for transmission in developed countries.