Oral hairy leukoplakia in healthy, immunocompetent individuals.

Oral hairy leukoplakia (OHL), while typically associated with HIV infection and immunosuppression, is rarely seen in HIV negative immunocompetent individuals. We report on two cases of OHL in immunocompetent patients.

Knowledge, attitudes and practices of oral health care workers in Lesotho regarding the management of patients with oral manifestations of HIV/AIDS.

Lesotho has the third highest prevalence of HIV in the world with an estimated 23% of the adult population infected. At least 70% of people living with HIV/AIDS (PLWHA) have presented with oral manifestation of HIV as the first sign of the disease. Oral health workers regularly encounter patients presenting with oral lesions associated with HIV disease and therefore need to have adequate knowledge of these conditions for diagnosis and management. The aim of the present study was to determine the knowledge, attitudes and practices of oral health care workers (OHCW) of Lesotho regarding the management of oral manifestations of HIV/AIDS. A descriptive cross-sectional survey was conducted on all 46 OHCW in 26 public and private care facilities in all ten districts of Lesotho. A self-administered questionnaire was used to gather information. The response rate was 100%. Nearly all (94.7%) agreed that oral lesions are common in people living with HIV and/or AIDS. The majority (91.3%) named oral candidiasis (OC) as the most common lesion found in PLWHA while Kaposi's Sarcoma (KS) (34.7%) and Oral Hairy Leukoplakia (OHL) (32.6%) were mentioned as the least common oral lesions of HIV. Most correctly identified the images of oral candidiasis (97.8%), angular cheilitis (86.9%) and herpes zoster (80.4%). Only 16.7% felt they had comprehensive knowledge of oral HIV lesions, although 84.8% reported having previously received training. Almost three quarters (71%) reported that there was no need to treat HIV positive patients differently from HIV negative patients. OHCW in Lesotho demonstrated high confidence levels in their competence in managing dental patients with oral lesions associated with HIV, however, they lacked an in-depth knowledge in this regard. Amongst this group there is a need for comprehensive training with regards to diagnosis and management of oral lesions of HIV including the training of other cadres of health care workers together with nurses and community health workers.

Oral lesions associated with human immunodeficiency virus disease.

Human immunodeficiency virus (HIV)-associated oral disease among people living with HIV infection includes oral candidiasis, oral hairy leukoplakia, Kaposi sarcoma, oral warts, herpes simplex virus ulcers, major aphthous ulcers or ulcers not otherwise specified, HIV salivary gland disease, and atypical gingival and periodontal diseases. Diagnosis of some oral lesions is based on clinical appearance and behavior, whereas others require biopsy, culture, or imaging for definitive diagnosis. Management strategies including pharmacologic and nonpharmacologic approaches are discussed in this article. Dentists also need to be cognizant of the potential oral side effects of HIV antiretroviral medications.

Tratamento da leucoplasia pilosa: revisão da literatura / Treatment of oral hairy leukoplakia: a literature review

Introdução: Pacientes com imunosupressão pela infecção do HIV (Human Immunodefi ciency Vírus) freqüentemente desenvolvem lesões de boca como a leucoplasia pilosa (LP). LP é uma lesão quase que exclusivamente observada em indivíduos infectados pelo HIV que apresentam uma baixa contagem de linfócitos T CD4. LP é assintomática e aparece como placa branca na borda lateral da língua, de superfície plana, corrugada ou pilosa e não removível quando raspada. A etiologia da LP é relacionada ao vírus Epstein-Barr, que pode ser identificado através de técnicas de microscopia eletrônica, hibridização "in situ", imunoistoquímica e reação em cadeia da polimerase. A citologia esfoliativa é uma boa opção para o diagnóstico da LP, por ser um método simples, confiável, seguro, não invasivo e não traumático. O tratamento da LP é recomendado para eliminar as pilosidades, restaurar o conforto do paciente, re-estabelecer as características normais da língua e eliminar nichos de bactérias, vírus e fungos desencadeadores de outras doenças da boca. Os tratamentos propostos na literatura para LP incluem cirurgia, terapia anti viral sistêmica e a terapia tópica. Objetivo: Realizar uma revisão de literatura sobre as opções de tratamento para a LP. Conclusão: A terapia tópica tem sido a mais recomendada, por ser de fácil aplicação, pouco invasiva, de baixo custo, com poucos efeitos colaterais e, principalmente, para eliminar as pilosidades e EBV, para restabelecer as características normais da língua sem desenvolvimento de resistência aos vírus e para eliminar nichos bacterianos e fúngicos. Indicações clínicas para esse tratamento devem incluir sintomas associados à lesão ou um desejo do paciente, por razões estéticas de eliminar a lesão.

Introduction: Patients with immunosupression caused by the human immunodeficiency virus (HIV) infection frequently develop oral lesions such as oral hairy leukoplakia (OHL). OHL is a lesion almost exclusively observed in HIV-infected individuals, who present low T CD4 lymphocyte count. OHL is asymptomatic and appears as a white plaque on the lateral border of the tongue, with fl at, corrugated or hairy surface, which is not detachable when scraped. The etiology of OHL is related to Epstein-Barr virus, which may be detected by electron microscopy, in situ hybridization, immunohistochemistry, and polymerase chain reaction techniques. Exfoliative cytology is a good option for the diagnosis of OHL, for being a simple, reliable, safe, noninvasive and non-traumatic method. The treatment of OHL is recommended to eliminate the filiform structures on lesion surface, provide comfort to the patient, re-establish the normal characteristics of the tongue and eliminate possible niches for bacteria, viruses and fungi that may cause other oral diseases. The treatments proposed in the literature for OHL include surgery, anti viral systemic therapy and topical therapy. Objective: This paper presents a literature review about the treatment options for OHL. Conclusion: Topical therapy has been the most recommended because it is easy to apply, is a low-invasive and low-cost procedure, and has few side effects. It is mainly indicated for removing the filiform structures on lesion surface, eradicating the Epstein-Barr virus, reestablishing the normal characteristics of the tongue without developing resistance to the virus, and eliminating bacterial and fungal niches. Clinical indications for this treatment should include symptoms associated with the lesion or the patient's desire of eliminating the lesion for esthetic reasons.

Tratamento tópico da leucoplasia pilosa bucal e desenvolvimento e validação de um instrumento para avaliação do conhecimento de cirurgiões dentistas sobre HIV/AIDS / Topical treatment for oral hairy leukoplakia and development and construct validation of a questionnaire for assessment od dentists knowledge about HIV/AIDS

A tese apresentada constou de duas pesquisas. A primeira foi um estudo de ensaio clínico randomizado com os objetivos de apresentar um novo tratamento tópico para a leucoplasia pilosa bucal (LPB), utilizando-se solução alcoólica de podofilina a 25% associada ao penciclovir creme a 1% (PP); avaliar variáveis de prognóstico que podem influenciar nos tratamentos tópicos com solução alcoólica de podofilina a 25% (P), com solução alcoólica de podofilina a 25% ao aciclovir a 5% (PA) e com PP; e avaliar o desempenho desses três protocolos de tratamento tópico através da cura ou não da LPB, do índice de cura em relação ao tempo e da recidiva doze meses após a cura. As variáveis de prognóstico avaliadas foram: gênero, idade, anos de educação formal, rota de transmissão, CD4, CD8, carga viral, plaquetas, candidíase oral, uso de terapia antiretroviral altamente ativa (HAART), uso prévio de aciclovir, uso prévio de antifúngico, uso de drogas injetáveis, uso de AZT, consumo de cigarro e álcool. Realizou-se também a pesquisa da presença do vírus Esptein-Barr (EBV) antes e depois do tratamento tópico da LBP. Os 42 pacientes HIV-positivos e portadores de 69 lesões de LPB foram recrutados aleatoriamente do Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias Orestes Diniz (CTR-DIP), em Belo Horizonte, Minas Gerais. A presença do EBV foi avaliada em 15 destes 42 pacientes, onde a extração do DNA foi realizada por meio de raspado da borda lateral de língua e amplificada pela reação em cadeia de polimerase (PCR) antes e após o tratamento tópico. A LPB foi diagnosticada pela citologia esfoliativa. O modelo proporcional de Cox foi usado para avaliar as variáveis de prognóstico e o desempenho dos três protocolos de tratamento...

Oral manifestations of HIV disease.

HIV-related oral conditions occur in a large proportion of patients, and frequently are misdiagnosed or inadequately treated. Dental expertise is necessary for appropriate management of oral manifestations of HIV infection or AIDS, but many patients do not receive adequate dental care. Common or notable HIV-related oral conditions include xerostomia, candidiasis, oral hairy leukoplakia, periodontal diseases such as linear gingival erythema and necrotizing ulcerative periodontitis, Kaposi's sarcoma, human papilloma virus-associated warts, and ulcerative conditions including herpes simplex virus lesions, recurrent aphthous ulcers, and neutropenic ulcers.

Leucoplasia pilosa: Análise estomatológica e sua importância dentro do contexto das lesöes bucais / Oral hairy leucoplakia: Stomatology analysis and its importance within the context of the oral lesions

O autor apresenta revisäo de literatura sobre a leucoplasia pilosa, abordando a etiopatogenia, características clínicas, histopatológicas, tratamento e prognóstico

Oral hairy leukoplakia: clinicopathologic features, pathogenesis, diagnosis, and clinical significance.

Oral hairy leukoplakia (OHL) is a lesion frequently, although not exclusively, observed in patients infected by human immunodeficiency viruses (HIV). OHL is clinically characterized by bilateral, often elevated, white patches of the lateral borders and dorsum of the tongue. Histologically, there is profound acanthosis, sometimes with koilocytic changes, and a lack of a notable inflammatory infiltrate. The koilocytic changes are due to intense replication of Epstein-Barr virus (EBV), while epithelial hyperplasia and acanthosis are likely to result from the combined action of the EBV-encoded proteins, latent membrane protein-1, and antiapoptotic BHRF1. How OHL is initiated and whether it develops after EBV reactivation from latency or superinfection remain unresolved; nevertheless, definitive diagnosis requires the demonstration of EBV replicating vegetatively in histological or cytological specimens. In patients with HIV infection, the development of OHL may herald severe HIV disease and the rapid onset of AIDS, but despite its title, OHL is not regarded as premalignant and is unlikely to give rise to oral squamous cell carcinoma.

Oral manifestations in HIV-infected patients: diagnosis and management.

Oral lesions have been observed since the beginning of the AIDS epidemic. The number of HIV-infected patients is still increasing, especially in the heterosexual population. Oral diseases in HIV-infected patients are often more difficult to diagnose because the clinical presentations may differ from the same diseases in HIV-negative patients. HIV-associated oral lesions have diagnostic, prognostic, and therapeutic impact. Approximately 10% of the HIV-infected population will have oral manifestations as a first sign of their disease. In HIV-infected men oral hairy leukoplakia and oral candidiasis are useful markers for disease progression. This article summarizes the oral manifestations and the management of oral health in persons with HIV infection.

[The recent data on the viral origin of hairy leukoplakia of the oral cavity (OHL)]. / Données récentes sur l'origine virale de la leucoplasie villeuse de la cavité buccale (LVB).

Buccal hairy leukoplakia is associated with Epstein-Barr and HIV virus infections. The main symptom is the characteristic hairy lesion on side parts of the tongue without any other clinical signs. Histologically, there are hyperkeratosis, vacuolar degeneration, and presence of Candida, but no inflammatory infiltration. Antiviral drugs led to the regression of lesions, but there is a trend to relapse when treatment is interrupted.