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What Are HIV Mouth Sores?

Mouth sores are one of the most common symptoms of human immunodeficiency virus (HIV). This symptom is more likely to occur at later stages of infection, including symptomatic HIV infection and acquired immunodeficiency syndrome (AIDS). It can also be a symptom of an infection developed as a result of HIV weakening the immune system or a side effect from antiretroviral therapy. In many cases, HIV mouth sores can be treated.

What Is HIV?

HIV is a virus that weakens the immune system by destroying the body’s CD4 cells which fight infection and disease. As an HIV-positive person’s CD4 count is reduced, they are more likely to get other infections and develop other health complications.

HIV is transmitted when someone comes into contact with certain bodily fluids from a person with HIV. These bodily fluids are limited to the following:

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  • Blood.
  • Semen.
  • Pre-seminal fluid.
  • Rectal fluids.
  • Vaginal fluids.
  • Breast milk.

In most cases, HIV is spread either through sexual contact with an infected partner or through sharing needles, syringes, or other equipment used to prepare drugs for injection with someone who has HIV. The virus can also be spread from being stuck with a needle contaminated with HIV or from mother to child during certain labor conditions or breastfeeding, although these sources of transmission are less common. HIV is not transmitted via air, water, or saliva. You can’t get it from sharing food, drinks, toilets, or other common objects.

Stages of HIV

There are several stages of HIV infection that are determined by the symptoms that are present. Mouth sores are one of the symptoms that may appear in later stages of the infection.

Stage 1: Acute primary infection

This is the initial stage that occurs about one to four weeks after getting HIV. The symptoms of acute primary infection are often quite similar to the flu and may include:

  • Fever.
  • Headache.
  • Fatigue.
  • Swollen lymph glands.
  • Rash.
  • Sore joints or muscles.
  • Sore throat.

Stage 2: Asymptomatic stage

This stage occurs after the symptoms from the acute primary infection stage have cleared up. The body produces HIV antibodies and all symptoms can disappear for up to 10 to 15 years. The virus is still active in the body during this time, however, so it’s possible to transmit HIV even when no symptoms are present. Getting HIV treatment during the asymptomatic stage can minimize damage to the immune system.

Stage 3: Symptomatic HIV infection

This stage begins to develop once the HIV infection has already done severe damage to the immune system. The body becomes less capable of fighting off infection and disease. Some of the symptoms of the third stage of HIV infection include:

  • Weight loss.
  • Chronic diarrhea.
  • Night sweats.
  • Fever.
  • Persistent cough.
  • Oral problems, including mouth sores.
  • Skin problems, such as lesions.
  • Regular infections.
  • Serious illness or disease.

Stage 4: AIDS

AIDS is diagnosed when an HIV-positive person develops opportunistic infections or diseases due to the damage the virus has wreaked on their immune system. As more health complications develop, the person becomes increasingly ill and may eventually die from one or more of the infections and diseases they’ve acquired.

Opportunistic Infections

In the later stages of HIV, opportunistic infections or diseases often develop as a result of a weakened immune system. Mouth sores and other oral problems are more likely to develop when a person has a lower CD4 cell count. Some of the HIV health complications which often feature mouth sores as one of the symptoms include:

  • Candidiasis: This common HIV-related infection, which is also known as thrush, can cause the mucous membranes of the mouth, tongue, and esophagus to develop a thick coating with white or yellowish patches. There may be redness or bleeding under these sores as well.
  • Ulcers: Also known as canker sores, this condition leads to the development of red mouth sores with a yellowish or grayish film on top. These sores are most likely to develop on the tongue or on the inside of the lips or cheeks.
  • Oral hairy leukoplakia: This condition, which is typically caused by the Epstein-Barr virus, can lead white patches to develop on the tongue or inside the cheeks and lower lip. They often have a thick or hair-like feel.
  • Warts: Mouth warts are usually small and rough and feature a white, gray or pinkish color. They often cluster together and look similar to cauliflower.
  • HPV: High-risk strains of human papillomavirus (HPV) may develop into oropharyngeal cancer. One of the symptoms of this type of cancer may be white or red patches on the tonsils. With low-risk strains of oral HPV, mouth lesions that look like warts may develop.

Treatment for HIV Mouth Sores

There are a number of ways that doctors may treat mouth sores caused by HIV or an HIV-related condition. For example, fungal and bacterial infections that cause mouth sores can often be treated with prescription pills. Mild sores, such as most canker sores, may be treated with a prescription mouthwash containing corticosteroids.

Persistent mouth sores, such as warts, may require minor surgical procedures such as cryotherapy (freezing off the wart) for removal. With serious infections and diseases, more aggressive treatments may be used to attack the condition rather than just treat the symptoms. For example, treatments for oral cancer may include chemotherapy, radiation, or surgery.

HIV Medication Side Effects

While there is no cure for HIV, it can usually be effectively treated using medications that slow the virus’s progression in the body. Most people with HIV take a combination of drugs known as antiretroviral therapy (ART). This treatment saves lives by reducing the viral load (the amount of HIV in the blood) dramatically. When HIV is only present at very low levels, most HIV-positive people are able to remain healthy and continue fighting off infections and diseases.

ART also functions as an excellent form of HIV prevention. If an individual’s viral load becomes so low that it’s undetectable, there is almost zero risk that they will sexually transmit HIV when having sex with an HIV-negative partner. For additional protection, the HIV-negative person can also take PrEP, which is up to 99% effective at preventing HIV.

Most HIV medications have few side effects, and unless they are severe, the benefits strongly outweigh the drawbacks. ART side effects may include:

  • Headache.
  • Dizziness.
  • Fatigue.
  • Nausea and vomiting.
  • Diarrhea.
  • Difficulty sleeping.
  • Dry mouth.
  • Rash.
  • Pain.

Mouth sores are not a common side effect, but they could result from an allergic reaction to ART medication called Stevens-Johnson syndrome, which is very serious and requires immediate medical attention. Fortunately, this is a rare side effect that most people taking ART do not experience.

Further Reading

About HIV/AIDS, Centers for Disease Control and Prevention, August 2019

Mouth Problems + HIV, National Institute of Dental and Craniofacial Research, March 2004

HIV Treatment Overview, HIV.gov, March 2019

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