Prosthodontic Management and Treatment Considerations for an HIV-Positive Patient with a Nonhealing Lesion of the Maxilla: A Clinical Case History Report

HIV-related mortality has dramatically decreased due to highly active antiretroviral therapy (HAART), especially protease inhibitors (PIs).1 As life expectancy of HIV patients increases, complications such as inflammatory lesions, trauma, and neoplasm in the head and neck area may arise. Osteonecrosis, or avascular necrosis of the bone, is an inflammatory condition associated with necrosis of the cellular elements of the bones and the jaws, and has recently been related to HIV infection and antiretroviral therapy.2–4 Osteonecrosis has been associated with advanced HIV disease, the presence of antiphospholipid antibodies, increased levels of triglycerides, chronic treatment with steroids, and the use of alcohol and tobacco.3 The incidence of osteonecrosis may be increasing since the introduction of HAART, and in particular PIs.2,3,5 PIs can condition P450 cytochrome activity; interact with membrane receptors, modifying numerous metabolic pathways; and interfere with vitamin D metabolism and bone reorganization.6

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