Oral Viral Lesion (Hairy Leukoplakia) Associated with Acquired
Immunodeficiency Syndrome
From October 1981 to June 1985, 13 (11%) of 123 patients with
hairy leukoplakia (HL) seen in San Francisco, California, were
additionally diagnosed as having acquired immunodeficiency syndrome
(AIDS). Eighty (73%) of the 110 patients who did not have AIDS at
the
time of HL diagnosis were followed (1). Twenty of these developed
AIDS within 1-33 months (mean 7.5 months) of HL diagnosis.
Seventy-nine serum specimens from the 123 patients with HL were
tested
for antibody to human T-lymphotropic virus type
III/lymphadenopathy-associated virus (HTLV-III/LAV) by indirect
immunofluorescence (2). Of these, 78 (99%) were positive. The one
negative result was also negative by Western blot test. All cases
met
the CDC case definition for AIDS.
Oral viral "hairy" leukoplakia of the tongue appears as raised
white areas of thickening on the tongue, usually on the lateral
border. The lesions may not respond to traditional antifungal
therapy
and appear to have unusual virologic features. Candida has been
reported on the surface of the HL lesions. A number of viruses,
including papilloma, herpes, and Epstein-Barr, have been identified
by
electron microscopy in biopsies obtained from the HL lesions. HL
was
first identified in San Francisco in 1981. The lesion has also
been
reported in patients examined in Los Angeles, California;
Baltimore,
Maryland; Ann Arbor, Michigan; Paris, France; Copenhagen, Denmark;
and
London, England.
Reported by D Greenspan, BDS, J Greenspan, BDS, University of
California, San Francisco, School of Dentistry; H Goldman, DDS, New
York University Dental Center, New York City; Dental Disease
Prevention Activity, Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: HL may be of diagnostic value as an early
indicator
of HTLV-III/LAV infections, especially when observed in combination
with other clinical findings. Approximately 95% of patients with
AIDS
and AIDS-related complex are reported to have cervical
lymphadenopathy
and other head and neck manifestations of disease, which may be
detected by dentists or others undertaking oral or facial
examination
(3).
Health-care providers, including dental personnel, are in a
unique
position to identify clinical oral symptoms and their potential
association with AIDS. Kaposi's sarcoma (KS), candidiasis,
recurrent
herpetic infections, and papillomas are oral manifestations that
have
been associated with AIDS. Unresolved candidiasis may be one of
the
earliest signs of AIDS in persons in groups at risk of acquiring
AIDS. Oral KS is virtually pathognomonic of AIDS in males aged
25-44
years. Squamous cell carcinomas, non-Hodgkins lymphomas, and
malignant melanomas have also been reported to occur in the oral
cavity in association with AIDS.
While careful histories and physical examinations alone will
not
identify persons with AIDS or related symptoms, oral findings,
including this newly reported oral lesion, are important diagnostic
tools for health-care providers in early identification and
treatment
of AIDS.
References
Greenspan D, Greenspan JS, Conant M, Peterson V, Silverman S
Jr,
DeSouza Y. Oral "hairy" leucoplakia in male homosexuals:
evidence of association with both papillomavirus and a
herpes-group virus. Lancet 1984;ii:831-4.
Levy JA, Hoffman AD, Kramer SM, Landis JA, Shimabukuro JM,
Oshiro
LS. Isolation of lymphocytopathic retroviruses from San
Francisco
patients with AIDS. Science 1984;225:840-2.
Hardie J. A 1985 update on AIDS. Journal of the Canadian
Dental
Association 1985;51:499-503.
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