HIV-Associated Aphthous Ulcers

Aphthous ulcers may be severe in HIV-infected patients (Fig. 33.19).
The pain may interfere with the patient's ability to eat.
Mucosal pain leads to difficulties with eating and drinking, with resultant weight loss and dehydration (see the discussion of mucous membranes in Chapter 21: Disorders of the Oral Cavity, Lips, and Tongue; see Figs. 21.1 to 21.4).

Management

Topical steroids may be applied directly to the ulcerations.
Stomatitis elixir, consisting of equal parts of magnesium carbonate or magnesium hydroxide suspension, viscous lidocaine, diphenhydramine elixir 12.5 mg/5 mL, and 1 g tetracycline powder, to be swished and spat out of the mouth as needed, is useful for pain.
Thalidomide (100 mg by mouth twice per day) is effective with notable toxic effects of sedation, neutropenia, peripheral neuropathy, and teratogenicity.