Winkler J R, Robertson P B
Department of Stomatology, University of California, San Francisco.
Oral Surg Oral Med Oral Pathol. 1992 Feb;73(2):145-50. doi: 10.1016/0030-4220(92)90186-t.
Patients with severe immunosuppression as a consequence of infection by human immunodeficiency virus (HIV) are at risk for a number of severe periodontal diseases. HIV-associated gingivitis and HIV-associated periodontitis (HIV-P) are seen exclusively in HIV-infected persons. In some cases HIV-P may extend into adjacent soft tissue and bone, resulting in necrotizing stomatitis of periodontal origin. In addition, acute necrotizing ulcerative gingivitis has also been reported to have an increased prevalence in HIV-infected patients. The clinical and microbiologic features of HIV-associated gingivitis and HIV-P suggest that these diseases are early and later stages of the same lesion, that results in severe gingival erythema, extensive soft tissue necrosis, and destruction of alveolar bone. Although acute necrotizing gingivitis and the initial stages of HIV-P share a number of clinical signs current evidence indicates that they are distinct pathologic processes. Treatment of these lesions requires debridement, local antimicrobial therapy, immediate follow-up care, and long-term maintenance. In addition, patients with systemic involvement or extensive and rapidly progressing lesions may require systemic antibiotics appropriate to the organisms that dominate the lesion.
因感染人类免疫缺陷病毒（HIV）而导致严重免疫抑制的患者，有患多种严重牙周疾病的风险。HIV相关性牙龈炎和HIV相关性牙周炎（HIV-P）仅见于HIV感染者。在某些情况下，HIV-P可能会扩展至相邻的软组织和骨骼，导致牙周源性坏死性口炎。此外，据报道，急性坏死性溃疡性牙龈炎在HIV感染患者中的患病率也有所增加。HIV相关性牙龈炎和HIV-P的临床及微生物学特征表明，这些疾病是同一病变的早期和晚期阶段，会导致严重的牙龈红斑、广泛的软组织坏死以及牙槽骨破坏。尽管急性坏死性牙龈炎和HIV-P的初始阶段有许多共同的临床体征，但目前的证据表明它们是不同的病理过程。这些病变的治疗需要清创、局部抗菌治疗、即时随访护理以及长期维持治疗。此外，有全身受累或病变广泛且进展迅速的患者可能需要使用针对病变中占主导地位的微生物的全身性抗生素。
