Pathogenesis:
Oral and genital ulcers resembling recurrent aphthous ulcers (RAUs) in HIV-positive patients are being reported with increasing frequency (MacPhail et al.). Recurrent aphthous ulcers are commonly diagnosed in two forms. The first form of RAUs resemble clusters of herpetiform type ulcerations. The second and more severe RAUs are large, painful necrotic ulcers. The etiology of RAUs remain unknown, however a number of factors have been cited including stress, infectious agents, and circulating growth factors (TNF). RAUs are commonly reported adverse events of treatment with ddC.
Sites of Infection:
Most commonly, the tongue and mucosal membranes of the oral cavity and esophagus. Aphthous genital ulceration has also been reported in various reports.
Diagnosis:
A biopsy may be required of large RAUs to exclude a malignancy or opportunistic infection diagnosis.
Treatment:
Thalidomide has been reported recently as an effective treatment for RAUs (ACTG 251). Jacobson et al. randomized 44 HIV-positive patients with recurrent aphthous ulcers to receive thalidomide 200 mg/day or placebo. 14/23 (61%) patients receiving thalidomide reported a complete response; 1/21 (5%) patients receiving placebo reported a complete response (P < 0.0001). Drowsiness was the primary toxicity reported.
REFERENCES:
MacPhail LA et al. Recurrent aphthous ulcers in assocation with HIV infection: diagnosis and treatment. Oral Surg Oral Med Oral Pathol 73:283-8, 1992.
Jacobson JM et al. Thalidomide for treatinent of HIV associated oral aphthous ulcers (ACTG 251). 2Oth ACTG, Washington DC, 1995.
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