Published: 2017-09-23

Low current Cd4+T cell count: prediction, for persistent herpetic gingivostomatitis in HIV-positive patients under antiretroviral therapy

S. K. Narendra, N. C. Sahani, Upendra Das, S. Tripathy


Background: Oral viral lesions associated with HIV infection are important since they affect the quality of life of the patient and are useful markers of disease progression and immunosuppression. The purpose of this study was to correlate the persistence of herpetic gingivostomatitis lesions with the current CD4+ T cell count for adherence of HIV-infected individuals to anti retroviral therapy (ART) and antiviral therapy.

Methods: 302 HIV +ve patients developing oral ulcers were included in this study. The herpes simplex viral infections associated with the oral manifestations were detected through Immuno histochemical staining. The quantitative analysis of oral ulceration was done by using mucositis index.CD4T cell count was correlated with clinical manifestations of extensiveness of oral ulcers, acute febrile condition and other constitutional symptoms during follow up of cases for the treatment with anti viral therapies.

Results: Association of herpes simplex viral infections was found in 72 out of 302 HIV+ ve cases. All the HSV +ve patients developed extensive oral mucsal lesions during the 1st week. Extensive lesions developed within 7 days in patients with CD4 count <200 due to HSV infection, remained more or less unchanged in the oral cavity up to 90 days although they were receiving antiretroviral and antiviral therapies. In HIV + patients with CD4 count >500, manifestation of mucosal ulcers due to acute herpetic gingivostomatitis was limited to a period of 1 to 2 weeks. Patients with CD4 count >200 <500 did not follow a definite pattern.

Conclusions: Persistent oropharyngeal mucosal ulcers along with acute febrile condition due to herpes simplex virus infection are associated with low CD4 T cell count in HIV + patients under antiretroviral therapy.


Herpetic gingivostomatitis, Herpes simplex infections, HIV Infections

Full Text:



Garber A, Klein E, Bruce S, Sankoh S, Mohideen P. Metformin-glibenclamide versus Flaitz CM1, Nichols CM, Hicks MJ. Herpesviridae-associated persistent mucocutaneous ulcers in acquired immunodeficiency syndrome. A clinicopathologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81(4):433-41.

Itin PH, Lautenschlager S. Viral lesions of the mouth in HIV-infected patients. Dermatology. 1997;194(1):1-7.

Tukutuku K, Muyembe-Tamfum L, Kayembe K, Odio W, Kandi K, Ntumba M. Oral manifestations of AIDS in a heterosexual population in a Zaire hospital. J Oral Pathol Med. 1990;19(5):232-4.

Regezi JA, Eversole LR, Barker BF, Rick GM, Silverman S. Herpes simplex and cytomegalovirus coinfected oral ulcers in HIV-positive patientsOral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81(1):55-62.

Heinic GS, Northfelt DW, Greenspan JS, Mac Phail LA, Greenspan D. Concurrent oral cytomegalovirus and herpes simplex virus infection in association with HIV infection. A case reports. Oral Surg Oral Med Oral Pathol. 1993;75(4):488-94.

Firth NA, Rich AM, Reade PC. Oral mucosal ulceration due to cytomegalovirus associated with human immunodeficiency virus infection. Case report and brief review. Aust Dent J. 1994;39(5):273-5.

Eisen D. The clinical characteristics of intraoral herpes simplex virus infection in 52 immunocompetent patients. - Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;86(4):432-7.

Fletcher CV. Treatment of herpesvirus infections in HIV-infected individuals. Ann Pharmacother. 1992;26(7-8):955-62.

Crawford KW, Wakabi S, Magala F, Kibuuka H, Liu M, Hamm TE. Evaluation of treatment outcomes for patients on first-line regimens in US President's Emergency Plan for AIDS Relief (PEPFAR) clinics in Uganda: predictors of virological and immunological response from RV288 analyses. HIV Med. 2015 Feb;16(2):95-104.

Ranganathan K, Hemalatha R. Oral lesions in HIV infection in developing countries: an overview. Adv Dent Res. 2006;19(1):63-8.

Spijkervet FKL, van Saene HKF, Panders AK, Vermey A, Mehta DM. Scoring irradiation mucositis in head and neck cancer patients. Journal of Oral Pathology & Medicine. 1989;18(3):167-71.

Woo SB, Lee SF. Oral recrudescent herpes simplex virus infection.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83(2):239-43.

Pasternak AO, de Bruin M, Bakker M, Berkhout B, Prins JM. High Current CD4+ T Cell Count Predicts Suboptimal Adherence to Antiretroviral Therapy PLoS One. 2015 Oct 15;10(10):e0140791.

Arduino PG, Porter SR. Herpes Simplex Virus Type 1 infection: overview on relevant clinico-pathological features, J Oral Pathol Med. 2008;37(2):107-21.

Huber MA. Herpes simplex type-1 virus infection. Quintessence Int. 2003;34(6):453-67.

Arduino PG, Porter SR. Oral and perioral herpes simplex virus type 1 (HSV- 1) infection: review of its management. Oral Dis. 2006;12(3):254-70.

Siegel MA. Diagnosis and management of recurrent herpes simplex infections. J Am Dent Assoc. 2002 Sep;133(9):1245-9.

Sciubba JJ. Herpes simplex and aphthous ulcerations: presentation, diagnosis and management--an update. Gen Dent. 2003;51(6):510-6.

Patton LL, Phelan JA, Ramos-Gomez FJ, Nittayananta W, Shiboski CH, Mbuguye TL. Prevalence and classification of HIV-associated oral lesions. Oral Dis 2002;8(2):98-109.

Lloyd A. HIV infection and AIDS. P N G Med J. 1996;39(3):174-80.

Beyene MB, Beyene HB. Predictors of Late HIV Diagnosis among Adult People Living with HIV/AIDS, Who Undertake an Initial CD4 T Cell Evaluation, Northern Ethiopia: A Case-Control Study. PLoS One. 2015 Oct 8;10(10):e0140004.

Baccaglini L, Atkinson JC, Patton LL, Glick M, Ficarra G, Peterson DE. Management of oral lesions in HIV-positive patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:S50.e1-23.