Introduction

HIV infection has spread rapidly within developing countries since it was first diagnosed in the early 1980s.  In particular the African continent has been the worst affected with the sub Saharan Africa harboring about 70% of the world's infected population.¹  Even within this endemic region, the burdens of the disease vary significantly from country to country.  Nigeria, with a seroprevalence level of 5.8% and a population of 3.5 million HIV infected individuals, is presently ranked as the fourth worst affected nation in the world after South Africa, India, and Ethiopia.¹

Poverty is a principal contributory factor to the epidemic in this region as it increases the vulnerability to HIV infection, while the infection itself impoverishes individuals as well.²  Thus, a vicious cycle of poverty and HIV infection is set into motion.  Poverty has also affected the effectiveness of managing the infection with very few having access to single antiretroviral drugs such as the highly active antiretroviral therapy (HAART).  As of this writing, only 15,000 out of the 3.5 million HIV infected persons are on antiretroviral drugs.³  Improved access to antiretroviral drugs, early diagnosis, and prompt treatment of opportunistic infections remains the primary focus of HIV infection management in the sub-Saharan region, including Nigeria.

The role of dentists in the early diagnosis of HIV infection has been highlighted in previous studies.^{4, 5}  Oral lesions have been observed since the beginning of the epidemic with approximately 10% of the HIV infected population presenting oral manifestations as a first stage of their disease.⁶  These oral lesions usually have diagnostic and prognostic roles in the management of HIV infection.⁷  The diagnostic potential of oral lesions is based on the fact some oral lesions, such as candidiasis, have been found to be strongly associated with HIV, while others like major salivary gland swellings are less likely to be associated.  However, with adequate management of HIV infection, oral lesions, such as candidiasis, no longer predominate; oral diseases such as HIV salivary gland diseases and oral warts are becoming more commonly seen in HIV infected individuals.⁸  Oral lesions are still strongly associated with the clinical stage of HIV infection, and the presence of these lesions can be used as additional markers of immunosuppression and AIDS.⁹  This fact is supported by Eyeson et al.⁷ who observed the prevalence and severity of these oral lesions inversely correlates with the level of immunosuppression.  This highlights the role of oral lesions as a prognostic indicator.

Salivary gland diseases are also important as diagnostic and prognostic indicators in HIV infection.  These salivary gland diseases include the enlargement of major salivary glands (with or without hypofunction) and xerostomia.¹⁰  In early lesions the submandibular and sublingual glands are often initially affected and enlarged.¹¹  However, as the disease progresses, more parotid gland swelling can be observed.^{9, 12}  As many as 5-10% of patients with HIV-1 infection have been reported to have parotid swelling¹³ with the incidence increasing to as high as 20% in AIDS patients.¹⁴

There are several case reports in the literature on parotid gland enlargement in HIV infection.^{14, 15}  However, the authors could not find any report in the literature about sub-Saharan Africa, which is the region worst affected by the epidemic.  This paper presents five cases of parotid gland enlargement seen in HIV infected persons in Nigeria and reports on the differing modes of management in a resource-constrained environment with poor access to antiretroviral therapy.  The implications for the overall health of these patients are also discussed.

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Citation Number: Vol. 6, No. 1, Page 135