Do ARVs cause mouth sores?

Dear doctor,

My sister who is HIV positive and was started on ARVs two months ago has painful sores in her mouth, which are making eating a real ordeal for her. She did not have these sores before starting ARVs and we have been wondering whether it is the ARVs, which have caused this problem. What can be done to help her?  Rebecca.

Answer

Dear Rebecca, the sores in your sister's mouth may not be related to ARVs, as you seem to suggest. Therefore, she needs to be assessed and a proper diagnosis made so that definitive treatment can be instituted depending on the cause of the ulcers. Stress, which is common among people living with HIV, can cause what are known as stress ulcers. These can make eating an ordeal for anyone who has them. Others causes of oral sores can be a virus known as herpes simplex or Kaposi's sarcoma; a cancer common in HIV infection.  In general, make sure she maintains strict oral hygiene by using an antiseptic or salt solution, which she should gargle after brushing her teeth. She should not swallow the antiseptic or salt solution after gargling. She should also increase her fluid in take and eat small but frequent meals, which should be soft therefore not requiring much chewing.  Aim at making sure she does not get dehydrated and that she takes in enough food to meet her body requirements and keep her strong. Lastly, your sister needs to be counseled concerning her treatment since treatment with ARVs; also known as antiretroviral therapy (ART) is treatment for life. If she takes it well with good adherence, she will be able to live a good quality life for a long time without succumbing to AIDS.