Common Tongue Conditions in People With HIV

Mouth and tongue lesions are often one of the first symptoms of human immunodeficiency virus (HIV). HIV weakens your immune system, which can leave you susceptible to sores and infections.

If left untreated, oral health issues can cause pain and other health complications.

Aphthous ulcers are small, yellow or gray sores with a red border. They usually appear on the tongue, cheeks, or inside the lips. Mouth ulcers can make talking and eating painful, especially if they’re located under the tongue.

Mouth ulcers are often a symptom of a weak immune system and stress. An estimated 50% of people with HIV experience mouth and tongue ulcers because of their weakened immune systems. Dry mouth caused by HIV and HIV medications can also increase your risk of mouth sores.

Sores will eventually heal on their own. Mild ulcers can be treated with over-the-counter (OTC) numbing creams that help relieve pain and promote healing. More severe sores are treated with prescription corticosteroid mouthwashes or pills.

Oral thrush is a type of yeast infection that causes patches of creamy white or yellow bumps that coat the tongue. These patches can be painless, or they may burn and bleed. Oral thrush can also affect the tonsils, throat, cheeks, gums, and roof of the mouth. 

Oral thrush is the most common mouth infection that affects people living with HIV. It’s normal for yeast (a type of fungus) to live in your mouth. However, if you have a weakened immune system due to HIV, it’s easier for this fungus to grow too much, leading to infection. Because saliva in the mouth has antibodies to fight infections, HIV-related dry mouth also increases your risk of oral thrush.

Prescription antifungal lozenges, pills, or mouthwashes can treat oral thrush. However, oral thrush often returns if your immune system is too weak.

Oral hairy leukoplakia (OHL) causes white, hair-like patches on the sides of the tongue. It can also appear on the insides of the cheeks and lower lip. These patches can be painless or cause mild pain. In more severe cases, you may lose your sense of taste and experience hot and cold sensitivity.

People with Epstein-Barr virus (EBV)—a common herpes virus—can develop oral hairy leukoplakia. EBV typically infects people with extremely weak immune systems, especially those with HIV. EBV infections are also more common in people with untreated HIV.

Oral hairy leukoplakia patches often go away randomly, but there is no cure for the underlying Epstein-Barr virus. Treatment for OHL may include prescription anti-retroviral medications to help reduce patches and lower EBV in your body. Topical solutions, like podophyllin resin and retinoids, can also be applied to the tongue to remove patches. 

Herpes simplex virus type 1 (HSV-1) can cause swollen, painful sores and blisters on the tongue. Blisters are also common on the lips and the roof of the mouth. Herpes blisters start as small clusters of white or yellow fluid-filled bumps that eventually burst into one larger red sore. 

Oral herpes affects nearly 20% of people with HIV. Living with a weak immune system increases your risk of having more oral herpes outbreaks, which can also spread more easily.

Herpes sores are very contagious and can spread from kissing or sharing utensils. There is no cure for oral herpes, but prescription antivirals can help reduce healing time and future outbreaks.

Oral warts look like small, hard, skin-colored bumps or flat, white growths that resemble cauliflower. These painless warts often appear on the tongue, lips, and inside of the mouth. On the tongue, warts usually look gray or white and grow on the sides of the tongue or the lingual frenulum (the fold underneath your tongue).

Oral warts are caused by different strains of the human papillomavirus (HPV). People with HIV are more likely to get HPV infections and oral warts because of their weakened immune system.

People who are aging with HIV or are doing highly active antiretroviral therapy (HAART) are also at an increased risk of oral warts. Oral warts can be removed surgically or frozen off with cryosurgery. However, warts can come back. 

Oral melanin hyperpigmentation looks like flat, brown patches on the tongue, lips, gums, cheeks, or roof of the mouth. This discoloration is caused by increased melanin (skin pigment) in the mouth.

If you have HIV, the antiretroviral therapy (ART) medication Retrovir (zidovudine), also known as AZT, can cause oral hyperpigmentation as a side effect. HIV-related oral hyperpigmentation doesn’t usually cause problems or require treatment. However, if you’re worried about the appearance of hyperpigmentation, talk with your healthcare provider. You may be able to switch to a different ART medication.

Maintaining good oral hygiene can help prevent HIV tongue and mouth conditions. Some dentist-approved tips include:

• Keep your mouth clean: Brush your teeth for two minutes and floss twice daily to remove food, plaque, and harmful bacteria in your mouth. 
• Visit your dentist regularly: See your dentist at least every six months for cleanings. If you don’t have a dentist, ask your healthcare provider or clinic for a referral. 
• Take your HIV medication: It’s important to take antiretroviral therapy medications as directed and on schedule to reduce HIV in your body and help your immune system recover.
• Avoid dry mouth triggers: Limit things that can lead to dry mouth, like smoking tobacco, drinking alcohol, and eating salty foods.
• Stay hydrated: Drink water often, use a humidifier at bedtime, and consider using toothpaste or mouthwash designed to help dry mouth.

If you have HIV, it’s important to see your provider if you experience any changes in your mouth or tongue. Mouth sores, dry mouth, and oral infections are often indicators that HIV is progressing and the immune system is becoming weaker. Some HIV medications can also make dry mouth worse, so your provider may recommend a different treatment.

If left untreated, oral health complications make you more susceptible to bacterial infections and septicemia (blood poisoning), which can be fatal with a weakened immune system. HIV-related tongue ulcers and dry mouth can cause pain that makes it hard to talk, chew, and swallow. Tongue lesions can also wear down taste buds and cause loss of taste.

Other warning signs of HIV progression that warrant a medical visit include:

• Fatigue
• Fever
• Chills
• Sore throat
• Mouth ulcers
• Rash
• Muscle aches
• Swollen lymph nodes
• Night sweats

The HIV Services Locator is a helpful tool to find qualified healthcare providers in your area.

People with HIV are more likely to have ulcers, oral thrush, dark spots, herpes, and warts that affect the tongue and mouth. Because HIV weakens your immune system and can cause dry mouth, oral health conditions are common.

Practicing good oral hygiene, taking your HIV medications, and visiting your dentist regularly are essential to help prevent complications.