ORAL MEDICINE Editor: Martin S. Greenberg Oral malignancies in HIV disease: Changes in disease presentation, increasing understanding of molecular pathogenesis, and current management Joel B. Epstein, DMD, MSD, FRCD(C), a Robert J. Cabay, MD, DDS, b and Michael Glick, DMD, c Chicago, Ill, and Newark, NJ UNIVERSITY OF ILLINOIS AND UNIVERSITY OF MEDICINE AND DENTISTRY OF NEW JERSEY Infection with human immunodeficiency virus (HIV) and progression to acquired immune deficiency syndrome (AIDS) are associated with a vide variety of morbidities. Local and systemic diseases can develop in association with HIV infection and may manifest themselves as malignancies of the oropharynx. Advances in HIV management, fueled by increasing understanding of molecular pathogenesis, have resulted in marked changes in the prevalence of oral malignant disease. This paper discusses recent trends in the presentation and treatment of malignancies related to HIV and AIDS with an emphasis on malignancies seen in the oral cavity. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:571-8) Advances in the management of the human immuno- deficiency virus (HIV) infection have resulted in significant changes in the prevalence and incidence of oral diseases found in individuals infected with HIV. 1,2 In countries where patients have access to effective antiretroviral therapy, people are living with chronic HIV infection for years, although immune suppression and progression due to acquired immune deficiency syndrome (AIDS) may ultimately occur. People with chronic immunosuppression due to HIV face a greater risk of developing malignant disease. Oral malignancies associated with HIV may reflect local head and neck disease or represent systemic malignant disease. The presence of oral malignancies varies with risk factors for transmission of HIV, including unprotected sexual activity, contact with blood or blood products, and injection drug use (IDU), and differs geographically based on behavior, viral cofactors, HIV therapy, and genetic variation. Understanding of the pathogenesis of oral malignant disease in HIV and progress in molecular biology has lead to improvements in treatment. The purpose of this report is to review intraoral malignant disease reported in the literature from 1996 to 2004 in light of ad- vancement in the understanding and treatment of HIV infection. MATERIAL AND METHODS A Medline search of material from January 1996 to January 2004 was conducted using the following search terms: oral malignancies, Kaposi sarcoma (KS) and oral Kaposi sarcoma (OKS), lymphoma and oral lymphoma, and HIV infection and AIDS. Additional references included in some of the papers were also reviewed. EPIDEMIOLOGY The spectrum of cancer in AIDS includes malignant disease with increased incidence of cancers, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), cervical cancer, KS, Hodgkin’s lymphoma (HL), non-Hodgkin’s lymphoma (NHL), seminoma, leio- myoma, and pediatric leiomyosarcoma. 3 HL and anogenital intraepithelial neoplasia have been associ- ated with HIV infection, but data related to risk of a Professor and Head, Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, and Director, Interdisciplinary Program in Oral Cancer, College of Medicine, Chicago Cancer Center, University of Illinois at Chicago. b Resident Physician, Department of Pathology, College of Medicine, University of Illinois at Chicago. c Professor and Chair, Department of Diagnostic Sciences, and Director, Division of Oral Medicine, New Jersey Dental School, University of Medicine and Dentistry of New Jersey. Received for publication Sep 15, 2004; accepted for publication Jan 10, 2005. 1079-2104/$ - see front matter Ó 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.tripleo.2005.01.015 571 Vol. 100 No. 5 November 2005