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HIV AIDS Symptoms: Oral Hairy Leukoplakia (OHL)
The symptoms of oral hairy leukoplakia are painless fuzzy white patches on the tongue.
Hairy leukoplakia is often a sign of HIV infection and an increased
likelihood of developing AIDS with the following possible complications:
* Chronic discomfort
* Infection of the lesion
* Oral cancer
It may be caused by the herpes /Epstein-Barr virus.
"Hairy" leukoplakia of the mouth is an unusual form of leukoplakia that
is seen mostly in HIV-positive people. It may be one of the first signs
of HIV infection. It can also appear in others when their immune
systems are not working well, such as after a bone marrow transplant.
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Oral hairy leukoplakia (OHL) is a disease of the mucosa first described in 1984. This pathology is associated with Epstein-Barr virus (EBV) and occurs mostly in people with HIV, both immunocompromised and immunocompetent, albeit it can affect patients who are HIV negative. The first case in an HIV-negative patient was reported in 1999 in a 56-year-old patient with acute lymphocytic leukemia. Later, many cases have been reported in heart, kidney, and bone marrow transplant recipients and patients with hematological malignancies.
The primary symptom of common leukoplakia, which is less dangerous if treated right away, is a skin lesion with the following characteristics:
o Usually on the tongue
o May be on the inside of the cheeks
o Can occur on the genitals of women
o The color is typically white or gray
o May be red -know as- erythroplakia
o Thick, slightly raised, hard surface
White patches usually appear on the tongue and sometimes on other places in the mouth. The condition may look like thrush, a type of candida infection that is also associated with HIV and AIDS in adults.
Hairy leukoplakia is one of the most common virally-induced, oral diseases of HIV infected individuals with a point prevalence as high as 25%-53%.1 The 6-year incidence of OHL in this patient population was reported to be around 32%. A significant trend to a lower prevalence was observed in the group of patients who were already taking antiretroviral therapy, non-HAART and HAART (p < 0.001 and p = 0.004, respectively).2
Fewer cases of OHL have been reported in non-HIV patients. This is probably due to underdiagnosis and underreporting of this disease in patients with hematological malignancies or solid organ transplantation. Some studies have shown the prevalence of OHL in renal transplant recipients to be more than 11%.
The incidence of OHL is similar to that in the United States and thereby
reflects the prevalence of HIV.
In populations where the prevalence of HIV is low, oral mucosal lesions alone
are poor predictors of HIV infection.3
Mortality/Morbidity
In patients with HIV, the median CD4 count when OHL is first detected is
468/µL. If these patients do not have AIDS-defining disease at the time OHL is
diagnosed, the probability of developing AIDS if not receiving highly active
antiretroviral therapy (HAART) is 48% by 16 months and 83% at 31 months. In
addition, studies have shown that patients with AIDS with OHL have a shorter
lifespan than those that do not present this lesion. Furthermore, if these
patients are concomitantly co-infected with hepatitis B virus, the risk of
early progression to AIDS increases 4-fold.
Predilection by Age, Race & Sex
No racial predilection has been established. OHL is most commonly observed in
homosexual men who are HIV positive, especially in those who smoke. No age
predilection has been established.
Exams and Tests
The typical white patch of leukoplakia develops slowly, over weeks to months.
The lesion may eventually become rough in texture, and may become sensitive to
touch, heat, spicy foods, or other irritation.
A biopsy of the lesion confirms the diagnosis. An examination of the biopsy
specimen may find changes that indicate oral cancer.
Treatment
The goal of treatment is to eliminate the lesion. Removal of the source of
irritation is important and may lead to disappearance of the lesion.
* Dental causes such as rough teeth, irregular denture surface, or
fillings should be treated as soon as possible.
* Smoking or other tobacco use should be stopped.
Surgical removal of the lesion may be necessary. The lesion is usually removed
in your health care provider's office with the use of local anesthesia.
Some research has shown that vitamin A or vitamin E may shrink lesions, but
this should only be administered with close supervision by a health care
provider.
Treatment of leukoplakia on the vulva is the same as treatment of oral
lesions.
Outlook (Prognosis)
Leukoplakia is usually harmless, and lesions usually clear in a few weeks or
months after the source of irritation is removed. Approximately 3% of
leukoplakia lesions develop cancerous changes.
The expected mortality Rate for Patients diagnosed with oral harily leukoplakia in patients with HIV: The median CD4 count when OHL is first detected is 468/µL. If these patients do not have AIDS-defining disease at the time OHL is diagnosed, the probability of developing AIDS if not receiving highly active antiretroviral therapy (HAART) is 48% by 16 months and 83% at 31 months. In addition, studies have shown that patients with AIDS with OHL have a shorter lifespan than those that do not present this lesion. Furthermore, if these patients are concomitantly co-infected with hepatitis B virus, the risk of early progression to AIDS increases 4-fold.
History
Patients may report a nonpainful white plaque along the lateral tongue borders. The appearance may change daily. The natural history of hairy leukoplakia is variable. Lesions may frequently appear and disappear spontaneously. Hairy leukoplakia is often asymptomatic, and many patients are unaware of its presence. Some patients with hairy leukoplakia do experience symptoms including mild pain, dysesthesia, alteration of taste, and the psychological impact of its unsightly cosmetic appearance.
Physical
Unilateral or bilateral nonpainful white lesions can be seen on the margins, dorsal or ventral surfaces of the tongue, or on buccal mucosa. The lesions may vary in appearance from smooth, flat, small lesions to irregular "hairy" or "feathery" lesions with prominent folds or projections.
Lesions may be either continuous or discontinuous along both tongue borders, and they are often not bilaterally symmetric. Lesions are adherent, and only the most superficial layers can be removed by scraping. There is no associated erythema or edema of the surrounding tissue. Hairy leukoplakia may also involve dorsal and ventral tongue surfaces, the buccal mucosa, or the gingiva. On the ventral tongue, buccal mucosa, or gingiva, the lesion may be flat and smooth, lacking the characteristic "hairy" appearance.
The cause of oral hairy leukoplakia is associated with HIV infection. It has been described in patients with other forms of severe immunodeficiency including those associated with chemotherapy, organ transplant, and leukemia. Rarely, it may occur in patients who are immunocompetent.
Oral hairy leukoplakia is described in association with Behçet syndrome and ulcerative colitis.
Smoking more than a pack of cigarettes a day is correlated with the development of OHL in HIV positive men.
Studies show no increase in oral hairy leukoplakia when controlled for number of oral sex partners (cunninglingus).
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