ORAL CHANGES IN CHILDREN WITH AIDS

Аннотация

Pediatric AIDS is associated with a broad spectrum of systemic complications, among which oral manifestations play a crucial diagnostic and prognostic role. This article examines the prevalence, types, and clinical relevance of oral changes observed in children with AIDS. Common conditions include candidiasis, linear gingival erythema, oral hairy leukoplakia, and herpetic lesions. These manifestations often reflect the degree of immunosuppression and may serve as early indicators of disease progression or antiretroviral therapy failure. Emphasis is placed on the need for interdisciplinary management, early diagnosis through routine oral screening, and the integration of dental care intopediatric HIV treatment protocols. Kеywоrds: pediatric AIDS, oral manifestations, HIV-related lesions, oral candidiasis, immunosuppression,dental care, opportunisticinfections. INTRОDUСTIОN Human Immunodeficiency Virus (HIV) infection in children leads to Acquired Immunodeficiency Syndrome (AIDS), a condition characterized by profound immunosuppression and multisystem involvement. The oral cavity is often one of the first sites to reflect the systemic deterioration associated with HIV, especially in pediatric patients whose immunesystems are stilldeveloping. Oral lesions can affect nutrition, speech, psychological well-being, and overall quality of life, making their recognition vital for early intervention. Children with AIDS are more prone to opportunistic infections, and due to differences in immunity and disease progression compared to adults, the pattern of oral changes may be unique. The presence, type, and severity of these lesions can provide insights into the patient's immunological status and therapeutic response, thereby supporting clinical decision-making. MАTЕRIАLSАND MЕTHОDS The occurrence of oral lesions often parallels the progression of AIDS and serves as a clinical marker for immunologic decline. For example, candidiasis may precede serological markers of HIV progression, making it an early warning sign. Moreover, certain lesions, such as LGE and OHL, are considered AIDS-defining conditions under WHO staging criteria forpediatric HIV [1]. RЕSULTSАNDDISСUSSIОN Management of oral manifestations requires coordinated care among pediatricians, infectious disease specialists, and dental professionals. Antiretroviral therapy (ART) plays a central role in lesion resolution; however, local antifungal or antiviral treatments are often 98,7:ROTCAFTCAPMI .SECNEICSLACIDEM,5202,yaM,5emuloV gro.srehsilbupcimedaca.www necessary. Preventive dental care, oral hygiene education, and nutritional support are equally importantin mitigating theimpact of oral diseases in HIV-positivechildren. The oral manifestations observed in HIV-positive children are largely attributable to progressive immune system impairment, particularly involving CD4+ T-lymphocyte depletion and altered cytokine signaling. In pediatric patients, whose immunological defenses are still maturing, the viral load tends to be higher and immune dysregulation more pronounced than in adults. This immunopathological backdrop renders the oral mucosa highly susceptibleto colonizationbyopportunisticfungi, viruses, and bacterial pathogens. The mucosal epithelium, serving as a primary barrier, becomes compromised due to HIV- associated reductions in salivary immunoglobulins (especially IgA) and antimicrobial peptides such as histatins and defensins. These deficits reduce resistance to microbial invasion, allowing even low-pathogenic flora to induce overt pathology. Furthermore, impaired neutrophil and macrophage function disrupts local immune responses, promoting chronicity andrecurrence oforal lesions [2]. Oral pathology in children with AIDS frequently compromises mastication, swallowing, and overall oral intake. Painful ulcerations, mucosal inflammation, or candidiasis can lead to reduced appetite and selective feeding behavior, thereby contributing to malnutrition. Moreover, recurrent infections often result in systemic catabolism and impaired nutrient absorption [3]. Longitudinal studies have established a strong correlation between chronic oral infections and growth faltering in HIV-positive pediatric populations. In resource-limited settings, this impact is magnified by food insecurity, delayed diagnosis, and limited access to therapeutic dental services. Thus, oral health should be prioritized not only for its local effects but also for its role in maintaining systemic nutritional status and supporting developmental outcomes. Beyond their physiological consequences, oral lesions exert a considerable psychosocial burden on HIV-infected children. Painful, visible, or malodorous oral conditions can lead to embarrassment, social withdrawal, and bullying — particularly in school-aged children. Adolescents may experience self-image disturbances, further exacerbated by stigma associated withHIV. Such psychosocial factors can hinder adherence to ART regimens and undermine o