Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Management of the
HIV/HCV Infected Patient
❚Diagnosis and Treatment
of Oral Manifestations
of HIV/HCV
Comprehensive Dental
Management of the
HIV/HCV Infected Patient
Human Immunodeficiency
Virus
Risk groups:
Injection drug users
Body piercing, tattooing with contaminated
equipment, blood products pre 1990
HCV Disease Progression
❚ Hemostatic function
❚ Susceptibility to infection
❚ Drug actions/interactions
❚ Ability to withstand treatment
Patient Management Cont.
❚ Frequent recalls
❚ Adjunctive use of antimicrobials and
chlorhexadine
Treatment Planning -
Endodontic Considerations
❚ Hemostatic function
❚ Susceptibility to infection
❚ Drug actions/interactions
❚ Ability to withstand treatment
Normal Lab Values
❚ Platelets/ml 150-300K
❚ Neutrophil cells/ml 2500-7000
❚ Hemoglobin g/dl 14-18 male,
12-16
female
❚ CD4 cells/ml 800-1500
Laboratory Markers of
Liver Disease
NORMAL MODERATE HIGH
Normal
Normal Moderate
Moderate High
Normal Moderate High
ELEVATION ELEVATION High
Elevation
Elevation
Elevation
SERUM 0.5-1.2 4-10 10-50
serum
serum
serum MG/DL
BILIRUBIN
bilirubin
bilirubin 0.5-1.2
0.5-1.2 4-10
4-10 10-50
10-50
bilirubin
ALT, 0.5-1.2
SGPT 0-50 U/L 400-2000 4-10
2000- 10-50
mg/dl
mg/dl 30,000
mg/dl
AST, SGOT 0-50U/L 400-2000 2000-
alkaline
alkaline
30,000
alkaline 0-250 U/L 250-750 >750
phosphatase
ALKALINE
phosphatase 0-50
0-50 250-750
250-750 >750
phosphatase 0-50
PHOSPHAT 250-750 >750
>750
U/L
U/L
ASE
U/L
Bleeding Problems
❚ Analgesics - acetaminophen,
narcotics, ASA, NSAIDS
❚ Anesthetics - lidocaine, procaine,
mepivicaine
❚ Antibiotics - erythromycin,
tetracycline, metronidazole,
clindamycin
Commonly Used Medications
Metabolized in the Liver Cont.
Candidiasis- Candida
albicans
Oral Candidiasis
❚ Hairy Leukoplakia
❚ Herpetic simplex ulceration
❚ Human Papillomatous growth
❚ Kaposi sarcoma
❚ Cytomegalovirus ulceration
Hairy Leukoplakia
❚ Usually in severely
immunocompromised individuals,
CD4<50
❚ Painful ulceration on any mucosal
surface with nonindurated borders
Cytomegalovirus
Ulceration Cont.
❚ Lymphoma
❚ Fibroma
❚ Minor/ recurrent apthous ulceration
❚ Major apthous ulceration
Lymphoma
Questions
Case Studies
Patient I