Mouth, throat and oesophagus problems
Mouth and throat problems are also common in HIV patients. Mouth and throat problems include sores at the corners of the mouth, and fungal infections of the oral mucosa and the oesophagus (the tube that connects the mouth and throat to the stomach). These problems are indicative of different WHO clinical stages (2 to 4), and you should refer PLHIV presenting these to the nearest health centre, with a degree of urgency related to the specific stage.
Angular chelitis: These are small chronic sores or cracks around the lips, often at the corners of the mouth (Figure 21.5). Angular chelitis occurs early in HIV infection, and is indicative of WHO clinical stage 2.
Recurrent mouth ulcers (aphtous ulcers): These are small sores or ulcers inside the mouth that appear repeatedly. Ulcers are painful, self-healing and can recur. They can also involve the gums and throat. Note that mouth ulcers are also common in people who are not HIV positive who, for example, have malnutrition. However, in PLHIV, the ulcers are usually severe, making food intake difficult.
Oral thrush: Also known as oral candidiasis, this is an infection of the lining of the mouth caused by a fungus called candida (the same organism that causes oesophageal thrush which is decribed below, and vaginal candidiasis; see Study Session 31). Oral thrush is a sign of clinical stage 3, and is characterised by white patches (although at times they may appear red) that can be removed with an oral spatula (Figure 21.7).