FIGURE 52.2 Palatal petechiae in streptococcal pharyngitis Oral lesions are the initial presenting sign in approximately half of children with perinatally acquired HIV infection Common lesions include oral candidiasis, parotid enlargement, herpes simplex vesicles or erosions, hairy leukoplakia, aphthous ulcers, linear gingival erythema, and necrotizing ulcerative gingivitis Highly active antiviral therapy decreases the frequency of oral lesions; increasing lesions may indicate advancing disease Dental–alveolar abscesses, commonly caused by streptococci or anaerobes, cause pain, erythema, and gingival swelling, sometimes with loosening or extrusion of the involved tooth Patients may also develop fever,