Retrospective analysis of the clinical behavior of oral hairy leukoplakia in 215 HIV-seropositive patients

Abstract Oral manifestations are common findings in human immunodeficiency virus (HIV) infected patients and frequently influence the overall health. Oral hairy leukoplakia (OHL) is strongly associated with HIV infection demonstrating its relationship with the individual's immune status and progression of immunosuppression. This study aims to retrospectively evaluate OHL in HIV patients, analyzing its incidence, demographic aspects and possible changes in clinical and epidemiological profile of the disease over 17 years. The records of 1600 HIV-infected patients were reviewed. The data were correlated and analyzed, considering HIV exposure category, age, gender, harmful habits, CD4 level, use and type of antiretroviral. OHL was observed in 215 (13.4%) patients. Most were men in the fourth decade of life, 171 (79.5%) and 112 (52,1%) respectively, but an increase in the incidence of OHL among female patients and those in the fifth decade of life was observed. Tobacco smoking was the most frequent harmful habit reported by 114 (68%) patients. OHL occurred mostly in patients with CD4 counts between 200 and 500 cells/mm3 35 (55.5%). The lower incidence of OHL was found among patients using at least one non-nucleoside reverse transcriptase inhibitor (NNRTI). OHL is related to CD4 count, use of ARVT and tobacco smoking and is also more prevalent in men in the fourth decade of life. These characteristics were recognized in absolute values, but when verifying the behavior over the years we noticed that the incidence of OHL is decreasing and its epidemiological characteristics changing.

Comparison of oral manifestations with CD4 count in HIV-infected patients.

Aim and Objective: This study was carried out with the primary aim of correlating oral changes and general changes of HIV-infected patients with their CD4 count. Materials and Methods: 124 patients were selected, and after taking their informed consent, they were subjected to detailed history taking and thorough clinical examination. Specific oral lesions and general physical changes were recorded. Every patient was subjected to laboratory investigation for CD4 count. All these findings were tabulated. The clinical observation and laboratory findings were subjected to critical analysis and correlated. Statistical test, i.e. Student's " t" test, was applied and objective conclusions were drawn. Result: Out of 124 patients, 40 had oral candidiasis, 6 had oral hairy leukoplakia, 12 had periodontal disease, 20 had xerostomia, 30 had melanin pigmentation, while 4 had HSV2, and atypical ulceration. Out of 40 patients with oral candidiasis, 28 patients had CD4 count <200 (group A), 10 patients were in group, B (CD4 count 200-500 cell/mm 3 ) and 2 patients in group C(CD4 >500 cell/mm 3 ). Oral hairy leukoplakia occurred in equal proportions in group A and B. These periodontal diseases were more commonly in group B; xerostomia and melanin pigmentation was equally seen in group A and B. Conclusion: Oral candidiasis, oral hairy leukoplakia, linear gingival erythema, necrotizing ulcerative gingivitis, and necrotizing ulcerative periodontitis are specific oral indicators which will definitely suggest to the dental surgeon that the disease is running a rapid downhill course and due to this the oral physician is in a position to raise a suspicion and alert the general physician regarding the declining immune status of patient.

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.

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

Método auxiliar no diagnóstico de leucoplasia pilosa em pacientes HIV positivos / Exfoliative cytology as an auxiliary diagnostic method for hairy leukoplakia in HIV positive patients

Os autores realizaram estudo citológico de esfregaços de borda lateral de língua de pacientes soropositivos para o Vírus da Imunodeficiência Humana (HIV) com lesöes clínicas sugestivas de leucoplasia pilosa, em pacientes sem a manifestaçäo clínica da lesäo e em pacientes soronegativos para o HIV. Foram encontrados resultados citológicos com características distintas de alteraçöes celulares de acordo com a presença ou ausência da infecçäo viral. Os autores recomendam que, diante de lesäo clínica sugestiva de leucoplasia pilosa em pacientes HIV positivos, se realize a citologia exfoliativa por ser uma técnica simples, näo invasiva, de fácil acesso e que pode confirmar o diagnóstico clínico da lesäo

Leucoplasia pilosa: revisäo da literatura e apresentaçäo de um caso / Hairy leukoplakia: review of the literature and report of a case

Os autores têm o objetivo de apresentar um caso de leucoplasia pilosa relacionada a paciente portador do vírus HIV. Seräo abordados os aspectos clínico, histopatológico e formulaçäo do diagnóstico, além de enfatizar-se o papel do cirurgiäo-dentista no diagnóstico das manifestaçöes bucais da AIDS