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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.


  1. 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.

  2. 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.

  3. Hardie J. A 1985 update on AIDS. Journal of the Canadian Dental Association 1985;51:499-503.

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