AN EVALUATION OF ORAL ULCERS IN PATIENTS WITH AIDS AND AIDS-RELATED COMPLEX

Background: Patients with HIV infection can have recurrent and persist ent oral ulcers, not attributable to known infectious agents. Objectiv e. Our aim was to evaluate prospectively oral ulcers in patients with HIV infection to determine whether an etiologic agent could be identif ied. Methods: Sixteen patients with HIV infection who had oral ulcers not attributable to known causes had culture of the base and a biopsy specimen taken from the ulcer. Cultures were obtained for herpes simpl ex and varicella-zoster viruses, mycobacteria, and fungi. By polymeras e chain reaction (PCR) analysis with primer/probe sets for herpes simp lex viruses 1 and 2, varicella-zoster virus, cytomegalovirus, human pa pillomavirus, and Mycobacterium tuberculosis, each biopsy specimen was analyzed for the presence of DNA from these organisms. Specimens were also evaluated histologically. Results: Histoplasmosis was detected h istologically in one biopsy specimen, candidiasis in a second, and her petic changes in a third. Viral cultures were positive for herpes simp lex virus 1 in four cases and herpes simplex virus 2 in one case. PCR analysis detected DNA for herpes simplex virus 1 in one case and herpe s simplex virus 2 in another; DNA from other pathogens was not identif ied. In the remaining eight patients, hematoxylin-and-eosin staining r evealed eosinophilic ulcers in five cases and nonspecific changes in t hree cases. Conclusion: The etiologic agent of recurrent or persistent oral ulcers in patients with AIDS and AIDS-related complex was not id entified in 50% of patients. PCR analysis was not useful. Herpes simpl ex virus or other pathogens were not detected in ulcers containing num erous eosinophils.