Glick and co-workers (1) have demonstrated that the presence of OHL in patients infected with the AIDS virus is a trustable marker for the progression of the HIV infection.
Greenspan and co-workers (2) as well as Moniaci and coworkers (3) have shown than 40 to 60% of patients infected with HIV convert to AIDS within 2 to 3 years after the development of OHL.
Husak and co-workers (4) evaluated the presence of OHL in 456 patients with HIV associated skin diseases from 1982 through 1992. Additionally a CD4+ T lymphocytes count was performed within 3 months of the oral examination. Seventy one of the 456 patients (15.6%) presented OHL mostly of the lateral border of the tongue. The 71 patients had significant immunosuppression (median CD4+ T lymphocytes count 235/microliter; median CD4+/CD8+ ratio, 0.3). The median survival time for those patients was 20 months which is much shorter than the median of 52 months survival time observed in other HIV+ patients without OHL. These authors concluded that even in patients with more than 300/microliter CD4+ T lymphocytes, OHL is associated with a poor prognosis. Ramirez-Amador et al (5) did a follow-up study in a cohort of 111 asymptomatic Mexican HIV+ patients to evaluate the prognostic value of hairy leukoplakia (HL) and oral candidiasis (OC). Fifty-four patients (51%) progressed to AIDS. Those patients with HL and/or OC, showed faster development of AIDS than patients without lesions or other HIV related manifestations. Oral lesions in HIV infection may be considered as markers of HIV infection progression. Sciubba (6) stated that OHL is highly correlated to HIV infection in most, but not all HIV+ patients.The detection of Epstein-Barr virus particles with subsequent molecular analytic verification of such and the absence of other potential viral candidates, such as papilloma and human immunodeficiency viruses, have led to a general acceptance of the Epstein-Barr virus as the cause of OHL.
Brandwein et al (7) using standard DNA in situ hybridization (ISH) to detect Epstein Barr virus (EBV) in lingual hairy leukoplakia, found EBV in all 11 specimens that were investigated. EBV was found in the basal and parabasal layers and strongly localized in the upper epithelial layers. Additionally these authors reported that in the same 11 specimes there was no evidence of human papilloma virus (HPV) or cytomegalovirus DNA. The authors concluded that there is no evidence to suggest that HPV is involved in the development of hairy leukoplakia.
Miranda and Lozada-Nur (8) as well as other authors (9,10) have reported the presence of lingual hairy leukoplakia in HIV-negative immunosuppressed and in immunocompetent patients. These authors comment on the importance of a thorough examination of the oral tissues in patients who are undergoing immunosuppressive therapy.
Gowdey et al (11) treated ten HIV+ patients with bilateral OHL of the tongue with one topical application of a solution of podophyllum resin 25%. One side of the bilateral lesion was treated the other side was not treated and served as control Both sides were evaluated at two days, one week, and one month by an investigator who had not been involved in the initial treatment and had no knowledge of which side had been treated. The most significant difference with the control side was noted after two days of treatment. The patients reported minimal side effects such as burning sensation, bad or altered taste, and pain. All these symptoms were reported to occur immediately after the topical application and were mild and of short duration. No systemic side effects were reported. The authors conclude that a single topical application of a solution of podophyllum resin 25% is efficacious in achieving significant short-term resolution of OHL.