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.

Ciências da Saúde: uma abordagem holística

“…Pode-se citar também a leucoplasia pilosa oral como uma manifestação oral decorrente da infecção por EBV. A doença apresenta-se como uma lesão assintomática, encontrada principalmente em pacientes imunossuprimidos (VALE et al, 2016). É clinicamente caracterizada por placas brancas elevadas (GUIDRY et al, 2017), de aparência felpuda ou ondulada (GREENSPAN et al, 2016), não removíveis por raspagem e localizadas principalmente em borda lateral de língua, podendo ocorrer bilateralmente (VALE et al, 2016).…”

“…A doença apresenta-se como uma lesão assintomática, encontrada principalmente em pacientes imunossuprimidos (VALE et al, 2016). É clinicamente caracterizada por placas brancas elevadas (GUIDRY et al, 2017), de aparência felpuda ou ondulada (GREENSPAN et al, 2016), não removíveis por raspagem e localizadas principalmente em borda lateral de língua, podendo ocorrer bilateralmente (VALE et al, 2016). Os estudos sugerem que a leucoplasia pilosa oral é resultante do processo direto de replicação do EBV, sendo assim, não está associada a infecção latente do vírus (GUIDRY et al, 2017).…”

Oral diseases and provider‐initiated HIV testing and counseling in diagnosing new HIV infection: A case report

“…In this case, the lesions were found in a patient with a very low CD4+ count. It has been reported that there was a significant relationship between the decreased CD4+ counts and the increased Candida colonization rate and the occurrence of OPC (Das, Saikia, Nath, & Phukan, 2016), or OHL emergence (Chattopadhyay et al., 2005; Vale, Martins, Silva, & Ortega, 2016). The administration of topical Nystatin oral suspension in this patient was changed to fluconazole per oral because the lesion regressed.…”

Diagnosis of Oral Hairy Leukoplakia: The Importance of EBV In Situ Hybridization

“…Some researchers also state that the presence of this lesion could indicate a therapeutic failure or serve as a marker of AIDS progression [ 4 , 7 , 9 , 25 ]. In our case, it was not possible to correlate the presence of OHL with an occasional failure of the treatment because patients with OHL had a viral load of 1.1 log ( P = 0.155), on average, or consider the lesion as a marker of AIDS progression because the correlation between presence of OHL and disease staging was not statistically significant ( P = 0.301).…”

“…The histopathological characteristics are not exclusive to this lesion, which may include hyperkeratosis, epithelial hyperplasia, ballooning degeneration, and discrete or even absent inflammatory mononuclear cells infiltrate. For this reason, the criteria used for the final diagnosis of OHL have been always discussed [ 2 , 7 ]. Previous study published by our group showed that among 36 cases of OHL diagnosed in clinical and histopathological basis, only 80.55% were EBV positive, confirming the previous diagnosis [ 8 ].…”