Abstract

Human Immunodeficiency Virus (HIV) significantly compromises the immune system, predisposing affected individuals to a wide range of opportunistic infections and neoplastic conditions. Among these, oral lesions are often the first clinical manifestations of HIV infection and serve as important indicators of immune status, disease progression, and treatment efficacy. This comprehensive overview synthesizes current knowledge on HIV-related oral lesions, emphasizing their epidemiology, pathogenesis, clinical features, diagnosis, and management strategies. Oral manifestations are among the earliest and most frequent indicators of HIV infection, affecting 30% to 80% of HIV-positive individuals depending on disease stage and access to antiretroviral therapy (ART). These lesions are classified into strongly associated, less commonly associated, and occasionally associated conditions with HIV, as per the classification by the EC-Clearinghouse and WHO Collaborating Centre. Strongly associated lesions include oral candidiasis, oral hairy leukoplakia, Kaposi’s sarcoma, and necrotizing ulcerative periodontitis. These conditions not only affect oral health and quality of life but also play a prognostic role, often correlating with declining CD4+ T-cell counts and increasing viral load. With the advent and widespread adoption of highly active antiretroviral therapy (HAART), the incidence and severity of many HIV-associated oral conditions have declined. However, certain lesions persist or manifest differently due to immunological reconstitution or other co-factors such as smoking, co-infections, and ART-induced salivary gland dysfunction. This review highlights the importance of early detection and the role of dental practitioners in the multidisciplinary management of HIV-infected individuals. It also explores diagnostic tools such as cytology, biopsy, and polymerase chain reaction (PCR) techniques for lesion identification, as well as evolving therapeutic approaches including antifungals, antivirals, and immune-modulating agents.