**7. Discussion and recommendations**

a course similar to that observed in classic KS. The pathogenesis of KS is related to human herpes virus type 8 (HHV-8) or herpes virus associated with Kaposi's sarcoma (SK-HV). This virus is transmitted through sexual contact, which explains the prevalence in men who have sex with men in the US and in heterosexual women in Africa. The clinical characteristics are variable, usually beginning as erythematous, violet or brownish, asymptomatic macules that

The manifestations of KS can compromise mucous membranes, such as the oral cavity and viscera, gastrointestinal tract, lungs and lymph nodes. Lesions in their evolution may grow, coalesce, form large plaques and envelop lymphatic vessels, leading to lymphoedema in the affected limb. KS can occur as the first manifestation of AIDS, concomitant with other mani-

Initially they manifest themselves with enlarged and enlarged blood vessels in the dermis, with large endothelial cells, protruding into the lumen. There is perivascular infiltrate composed of lymphocytes, plasma cells and some macrophages, and groups of extravagant erythrocytes and hemosiderin deposits can be visualized. Several skin lesions, both inflammatory and neoplastic, should be included in the differential diagnosis: purpura, hemangiomas, bacillary angiomatosis, lichen planar dermatofibroma, pink pityriasis, fungal mycosis, nevi, malignant melanoma,

Its etiology comes from the chronic stimulation of B cells and its incidence occurs with late manifestations, mainly located in the gingiva. For more than 30 years the relationship between immunodeficiency and non-Hodgkin's lymphoma is known, relating to AIDS. Non-Hodgkin's lymphoma is evidenced by polygamous hypergammaglobulinemia, cytokines, and growth factors: 11–6; 11–10. Since the beginning of the epidemic the CDC defines HIV+ patients with

The diagnosis may be clinical, associated with biopsy, radiographs, CT scans, MRI [17].

It is the most common malignant neoplasm of the oral cavity, corresponding to 95% of the tumors of the patients, of form. We highlight the growing prevalence of HIV/AIDS patients. According to the National Institute of Cancer (INCA)/Ministry of Health (MS), the estimate for 2018, regarding the number of cases of oral cancer in general in Brazil, is 14,700 new cases, considering the region as the seventh most frequently affected by malignant tumors in the

Clinical features include ulcerated superficial, endophytic lesions (infiltrative ulcer and destructive ulcer), exophytic lesions (moriform vegetative, papilliferous vegetative and cauliflower vegetation), nodular (sub mucosa and deep) lesions. The most common clinical feature of squamous cell carcinoma is chronic ulcer. Due to this ulcerated clinical aspect, often granulomatous, we

cutaneous lymphoma and secondary syphilis were reported as SK simulators [19].

develop into papules, plaques, nodules or tumor lesions.

festations or late in the course of the disease.

164 Advances in HIV and AIDS Control

**5. Non-Hodgkin lymphoma**

**6. Epidermal carcinoma**

Brazilian population.

a diagnosis of non-Hodgkin's lymphoma as AIDS [17].

The relationship of the dentist to the patient's physician should result in knowledge of modifying factors that may interfere with dental treatment. See **Table 1**, which highlights these factors.

#### **7.1. Evaluation of medical factors modifying the dental treatment**

Treatment of human papilloma virus can be surgical (incisional biopsy) or cryotherapy, highpower laser therapy (CO<sup>2</sup> ), topical application of 25% podophylline alcoholic solution, topical application of 90% trichloroacetic acid (ATA) or medications such as Wartec®-Podofilotoxin and Aldara® Cream-Imiquimod Gel [8, 13–15, 22].

In relation to Kaposi's sarcoma, the biopsy is predominant to establish the diagnosis. Treatment of KS includes antiretroviral drugs, since the lesions usually regress with improved immune compromise. Localized destructive treatments may be indicated for isolated or sporadic injuries, such as cryotherapy with liquid nitrogen. Radiation therapy is effective for painful lesions of palms and plants and when there is edema. Intralesional injection of vinblastine may be effective if the patient has few lesions, but the method is associated with pain caused by the injection. The combination of traditional chemotherapeutic agents, such as vinblastine, etoposide (VP-16) and adriamycin, produces regression of SK lesions, but these drugs are myelosuppressive and potentially immunosuppressive. Vincristine and bleomycin, nonmyelotoxic drugs, can be used with good results. Interferon can be used both intralesional and systemically. Doxorubicin and liposomal daunorubicin are also effective [17–19].

Treatment of Non-Hodgkin lymphoma may be via prophylaxis with infiltration into the central nervous system of cytarabine or methotrexate medications. Also noteworthy is the study of the use of antiviral, and growth factors should be observed, and the administration of prophylaxis for the treatment of *Pneumocystis carinii* (*jirovecii*) should be considered [17].

Epidermal carcinoma shows the main locations are the lower lip, tongue border, floor of mouth and gum. There are important factors and determinants of risks such as: heredity, sex,


**Table 1.** Medical factors modifying dental treatment.

age and race. The treatment protocols and procedures go through surgical removal, chemotherapy and radiotherapy [20, 21].

http://Scielo.Isciii.Es/Scielo.Php?Script=Sci\_Arttext&Pid=S0213-12852006000600003&Lng=Es.

Oral Neoplasms in HIV Positive Patient http://dx.doi.org/10.5772/intechopen.78764 167

[10] Santos CC, Giovani EM. Xerostomy, caries and in black people with periodontal disease in black people periodontal disease risk studies HIV/AIDS. Landmark Research Journals

[11] Bhayat A, Yengopal V, Rudolph M. Predictive value of group I oral lesions for HIV infection. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology. 2010;**109**:720-723 [12] Filho AC, Abrão P. Alterações metabólicas do paciente infectado por HIV. Arquivos

[13] Stoopler ET, Balasubramaniam R. Human papillomavirus lesions of the oral cavity. New

[14] Bouda M, Vg G, Ng K, et al. "High risk" Hpv types are frequently detected in potentially malignant oral lesions, but not in normal mucosa. Modern Pathology. 2000;**13**(6):644-653

[15] Giovani EM, Santos CC, Georgevich Neto R, Noro-Filho GA, Caputo BV. Diagnosis of bone changes in mandibles of aids patients who had administered haart and developed lipodistrophic syndrome. Landmark Research Journal of Medicine and Medical

[16] Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, Jiang B, Goodman MT, Sibug-Saber M, Cozen W, Liu L, Lynch CF, Wentzensen N, Jordan RC, Altekruse S, Anderson WF, Rosenberg PS, Gilisson ML. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. Journal of Clinical Oncology.

[17] Greenspan D et al. Incidence of oral lesions in HIV-1-infected women: Reduction with

[18] Glick M et al. Oral manifestations associated with HIV-related disease as markers for immune suppression and aids. Oral Surgery Oral Medicine Oral Pathology.

[19] Coogan MM, Greenspan J, Challacombe SJ. Oral lesions in infection with human immu-

[20] Brau N et al. Presentation and outcome of hepatocellular carcinoma in HIV-infected patients: A U.S.–Canadian multicenter study. Journal of Hepatology. 2007;**47**:527-537 [21] Hodgson TA, Greenspan D, Greespan JS. Oral lesion of disease and HAART in industrialized countries. Advances in Dental Research. 2006;**19**:57-62. Disponível em: http://

[22] Giovani EM, Martins RB, JAJ M, Tortamano N. Use of GaAlAs laser in the treatment of necrotizing ulcerative periodontitis in patients seropositive for HIV/AIDS. Journal of

nodeficiency virus. Bulletin of the World Health Organization. 2005;**9**:83

HAART. Journal of Dental Research. 2004;**83**(2):145-150

www.spcd.org.br/prevencao01.htm [acessado em 14/07/10]

Oral Laser Applications. 2007;**07**(1):55-64

DOI: 10.4321/S0213-12852006000600003

of Medicine And Medical Sciences. 2017;**4**(2):025-030

England Journal of Medicine. 2011;**365**:E37

Sciences. 2017;**4**(5):058-067

2011;**29**(32):4294-4301

1994;**77**(4):344-349

Brasileiros de Endocrinologia & Metabologia São Paulo. 2007;**1**:51
