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         Hairy Leukoplakia:     more detail

1. OI: Oral Hairy Leukoplakia -- ÆGIS
. Oralhairy leukoplakia (OHL) is often the first opportunistic to appear.......Oral hairy leukoplakia. OHL Classification. virus
http://www.aegis.com/topics/oi/oi-ohl.html
Oral Hairy Leukoplakia
"O.H.L." This is part of a series on Opportunistic Infections ("OIs"). Please note that
  • This Page Is Just A Starting Point: who specializes in treating HIV.
  • Finding The Latest Information: Advances in treating opportunistic infections can happen at any time, so the material on this page may be outdated. Some links in the see also section at the bottom of this page are actually special database links. They may contain information published after this page was written.
    Classification
    virus
    Description
    • Oral Hairy Leukoplakia (OHL) is often the first opportunistic to appear.
    • Symptoms include white lesions on the edgest of the tongue.
    • OHL is caused by the Epstein-Barr virus (EBV).
    • It occurs almost exclusively in men with HIV. This opportunistic infection indicates serious damage to the immune system.
    • The US Centers For Disease Control considers this a Category B (ARC-defining) illness.
    Danger Zone
    • O.H.L. is possible at any CD4+ range, but it is more likely in those with CD4+ counts under 200 cells/mm.
    NOTE: If you are undergoing treatment that has increased your CD4+ levels, see the important note on
  • 2. Hairy Leukoplakia
    All about hairy leukoplakia from RXAddict.com hairy leukoplakia. General 'hairy leukoplakia' Links 1. Orbitz Airlines, Hotels, Rentals, Travel Deals
    http://www.maxillofacialcenter.com/BondBook/mucosa/hairyleuk.html
    Hairy Leukoplakia in AIDS
    Quick Summary
    Introduction

    References

    Photos
    ...
    Prognosis

    The Gauley River in West Virginia, above the dam.
    Quick Review
    Hairy leukoplakia is a unique whitish, irregular plaque of the side of the tongue, sometimes with surface projections long enough to appear to be "hairs" but usually with only a granular or nodular appearance. It rarely is seen at on the cheek mucosa near the corners of the lips, and look-alike lesions have been reported in HIV-negative patients, especially those with lichen planus. This lesion causes no significant problem but it is a sign of AIDS, hence, the treatment is directed at the generalized and very serious HIV virus disease. While the virus is under control, hairy leukoplakia diminishes or disappears. Most lesions have virus, bacteria and fungi within them but they are not considered contagious in the usual sense. Top of This Page
    Introduction Note: click on underlined words for more detail or photos. A well-demarcated, painless, verruciform hyperkeratotic lesion of the lateral tongue in HIV-infected male homosexuals was first reported in 1981 as

    3. Oral Manifestations Of AIDS
    classically described intraoral lesion of AIDS is oral hairy leukoplakia (OHL). This lesion as a rule develops on the
    http://www.dent.ucla.edu/pic/members/oralaids/viral/ohl/ohl.html
    Frequent Oral Diseases in HIV Positive and AIDS Patients
    Dr. Heddie O. Sedano, DDS
    At the end of this lecture, you will be asked if you would like to take this course for continuing education units.
    California Continuing Education Credits: 2 units Back to Classification
    Oral Hairy Leukoplakia (OHL)
    OHL tends to manifest in patients who's CD4+ cell count falls below 300 cells per cubic millimiter. There have been several studies which have demonstrated the importance of OHL as a determinant of the prognosis of AIDS. These studies have shown that patients with OHL have a shorter life span than those that do not present this lesion. This might implicate that the status of the immune system in those patients with OHL is at a lower level than those that do not have OHL. OHL is generally not treated unless it is requested by the patient because of aesthetics, masticatory or phonetic reasons. OHL resolve in patients which undergo treatment with AZT (zidovudine). This 24 year-old man presented these barely visible, vertical striations on both sides of his tongue. Note their almost parallel orientation. These lesions did not rub off. The clinical diagnosis of OHL was established. Additionally, the patient had a large tonsilar abscess and a weight loss of 15 pounds in the last 2 months. He attibuted the loss of weight to change in his diet. The patient denied belonging to any AIDS risk group but a Western blot and ELISA test, when performed, were positive and his CD4+ cell count was 280 cells per cubic millimeter. Then, the diagnosis of AIDS was established.

    4. Leukoplakia, Hairy
    Leukoplakia, Hairy. hairy leukoplakia of tongue in AIDS. hairy leukoplakia of tongue in AIDS
    http://www.brisbio.ac.uk/ROADS/subject-listing/leukoplakiahairy.html
    A collection of medical, dental and veterinary images for use in teaching. Home About the Archive FAQ Terms and Conditions ... Help
    Leukoplakia, Hairy
    Hairy leukoplakia of tongue in AIDS Hairy leukoplakia of tongue in AIDS Hairy leukoplakia Hairy leukoplakia Hairy leukoplakia

    5. Forum On HIV And Oral Health -- The Body: An AIDS And HIV Information Resource
    Information resources on hairy leukoplakia (HK) and other oral conditions, including FAQs, from The Body.
    http://www.thebody.com/cgi/oralans.html
    Opportunistic Infections and Side Effects of HIV Treatment
    Please remember that this forum is designed for educational purposes only, and experts are not engaged through this forum in rendering legal or medical advice or professional services. Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither The Body nor any sponsor is the publisher or speaker of posted visitors' questions or the experts' material. Questions and messages posted to this forum are not statements of advice, opinion, or information of The Body, Body Health Resources Corporation or any sponsor of this forum. While neither The Body nor Body Health Resources Corporation regularly reviews posted content, we reserve the right to delete, move, or edit postings if we deem it appropriate under the circumstances. Visitors submitting questions remain solely responsible for the content of their messages. Information provided by experts is general only and should not be used for diagnosing or treating a health problem or a disease, or relied upon as legal or other professional advice. This information is not a substitute for professional advice or care. If you have or suspect you may have a health or legal problem, you should consult your own health care provider or your attorney.

    6. AEGiS-RITA!: FOR THE CLINICIAN: Oral Hairy Leukoplakia: An Epstein-Barr Virus-as
    EBV is also an opportunistic pathogen in immunocompromised patients, associatedwith lymphoproliferative diseases and oral hairy leukoplakia.
    http://www.aegis.com/pubs/rita/2000/RI001203.html
    Important note: Information in this article was accurate in December 2000. The state of the art may have changed since the publication date.
    FOR THE CLINICIAN: Oral hairy leukoplakia: an Epstein-Barr virus-associated disease of patients with HIV
    Research Initiative Treatment Action (RITA!); Vol 6, No. 4 December 2000
    Dennis M. Walling, MD, The University of Texas Medical Branch at Galveston
    Introduction and background.
    EBV infection is transmitted from person to person by contact with infectious body fluids. Oral contact with infectious saliva is the most common route of transmission, but EBV infection may also be transmitted by sexual contact or exposure to breast milk. Like all herpesviruses, EBV establishes a life-long, persistent infection of its host. Acquisition of HIV infection stimulates reactivation of pre-existing, latent EBV infection. Asymptomatic, high level, oral EBV shedding occurs in up to 90% of HIV-infected patients, even before the clinical manifestations of immunodeficiency are apparent. While not all HIV-infected patients develop EBV-associated disease, persistent EBV replication and progressive immune dysfunction can eventually result in oral hairy leukoplakia and/or EBV-associated lymphoma Epidemiology.

    7. Geographic Tongue
    hairy leukoplakia Hairy Tongue. Black Tongue. Furry Tongue. Page, Tongue Index.
    http://www.fpnotebook.com/ENT168.htm
    Home About Links Index ... Editor's Choice Paid Advertisement (click above). Please see the privacy statement Otolaryngology Tongue Assorted Pages Geographic Tongue Hairy leukoplakia Indented Lateral Margins of Tongue Cranial Nerve 12 Paralysis ... Tongue Pain Geographic Tongue Migratory Glossitis Glossitis Areata Exfoliativa Median Rhomboid Glossitis Book Home Page Cardiovascular Medicine Dental Dermatology Emergency Medicine Endocrinology Gastroenterology General Medicine Geriatric Medicine Gynecology Hematology and Oncology HIV Infectious Disease Jokes Laboratory Neonatology Nephrology Neurology Obstetrics Ophthalmology Orthopedics Otolaryngology Pediatrics Pharmacology Prevention Psychiatry Pulmonology Radiology Rheumatology Sports Medicine Surgery Urology Chapter Otolaryngology Index Allergy Dermatology Ear Disease Examination Hearing Hematology and Oncology Infectious Disease Laboratory Laryngeal Disease General Lip Throat Disease Neurology Nasal Disease Obstetrics Pharmacology Procedure Radiology Salivary Sinus Disease Sports Medicine Symptom Evaluation Tongue Vertigo Page Tongue Index Geographic Hairy Leukoplakia Indented Paralysis Scrotal Smooth Varicosities
  • Pathophysiology Very common and benign condition Symptoms Asymptomatic Signs Scattered bright red areas on Tongue dorsum Denuded of papillae, smooth
  • 8. Oral Hairy Leukoplakia - The Body: An AIDS And HIV Information Resource
    Oral hairy leukoplakia. hairy leukoplakia (Jan 27, 2002) OHL or not (Apr 26, 2001) OHL (Apr 26, 2001) OHL on one side only? (Apr
    http://www.thebody.com/Forums/AIDS/Oral/Archive/Leukoplakia/
    Home Forum on HIV and Oral Health Answers to Questions by Category
    Oral Hairy Leukoplakia

    hairy leukoplakia
    (Jan 27, 2002)
    OHL or not...
    (Apr 26, 2001)
    OHL
    (Apr 26, 2001)
    OHL on one side only?
    (Apr 8, 2001)
    hairy tounge and OHL
    (Jan 18, 2001)
    Leukoplakia signs and symptoms...
    (Jan 18, 2001)
    PLS. ANSWER, I KNOW YOU'RE BUSY!!!!!!!!!
    (Sep 27, 2000)
    hairy tongue or oral hairy leukoplakia
    (Aug 18, 2000)
    SLIDE QUESTION
    (Jul 11, 2000) Shape of Hairy Leukoplakia (Jun 11, 2000) leukoplakia (Apr 28, 2000) I wrote earlier about geographic tongue and lichen planus... (Apr 24, 2000) OHL as only symptom..or not OHL at all (Apr 24, 2000) leukoplakia ? (Mar 8, 2000) Hairy Tongue and OHL (Mar 2, 2000) Hairy Leukoplakia (Feb 22, 2000) leukoplakia (Jan 12, 2000) OHL question-please respond (Jul 26, 1999) but they all look the same! (Jul 12, 1999) OHL = HIV? (Jul 1, 1999) hi dave i need your advice (May 17, 1999) Please remember that this forum is designed for educational purposes only, and experts are not engaged in rendering medical advice or professional services. Information they provide is general only, and should not be used for diagnosing or treating a health problem or a disease. This information is not a substitute for professional care. If you have or suspect you may have a health problem, you should consult your health care provider. Experts appearing on this page are independent. They are solely responsible for editing and fact-checking their material. Neither The Body nor any sponsor is the publisher or speaker of their material.

    9. The Body: The Center For AIDS: RITA! -- Oral Hairy Leukoplakia: An Epstein-Barr
    Oral hairy leukoplakia An EpsteinBarr Virus-Associated Disease of Patients withHIV, in RITA!, from The Center for AIDS Hope and Remembrance Project, at The
    http://www.thebody.com/cfa/rita_dec00/leukoplakia.html
    Research Initiative/ Treatment Action
    From the Center for AIDS Hope and Remembrance Project
    December 2000
    For the Clinician
    Oral Hairy Leukoplakia: An Epstein-Barr Virus-Associated Disease of Patients with HIV
    By Dennis M. Walling, M.D., The University of Texas Medical Branch at Galveston
    Introduction and Background
    Epstein-Barr virus (EBV) is a ubiquitous human herpesvirus that infects nearly every human being by young adulthood. Most EBV infections occur asymptomatically during childhood, but EBV is associated with a wide variety of human diseases including the infectious mononucleosis syndrome, Hodgkin's lymphoma, African Burkitt's lymphoma, and nasopharyngeal carcinoma. EBV is also an opportunistic pathogen in immunocompromised patients, associated with lymphoproliferative diseases and oral hairy leukoplakia. EBV infection is transmitted from person to person by contact with infectious body fluids. Oral contact with infectious saliva is the most common route of transmission, but EBV infection may also be transmitted by sexual contact or exposure to breast milk. Like all herpesviruses, EBV establishes a life-long, persistent infection of its host. Acquisition of HIV infection stimulates reactivation of pre-existing, latent EBV infection. Asymptomatic, high level, oral EBV shedding occurs in up to 90% of HIV-infected patients, even before the clinical manifestations of immunodeficiency are apparent. While not all HIV-infected patients develop EBV-associated disease, persistent EBV replication and progressive immune dysfunction can eventually result in oral hairy leukoplakia and/or EBV-associated

    10. AYC: Opportunistic Infections: Oral Hairy Leukoplakia (Ohl)
    Opportunistic Infections Oral hairy leukoplakia (Ohl) Basic Information. Oralhairy leukoplakia (OHL) is a viral infection of the oral cavity.
    http://alwaysyourchoice.com/ayc/hiv/hiv_disease/ohl.php
    HIV Issues and Topics Prevention HIV Disease Candiasis ... Information Opportunistic Infections: Oral Hairy Leukoplakia (Ohl) Basic Information The mouth is important both for diagnosis and prognostic staging of HIV and oral manifestations of HIV occur in 40% of patients with HIV infection. In patients diagnosed with AIDS, oral lesions have been reported in over 90% at some point in the course of the disease, increasing in incidence with advanced HIV disease. Oral hairy leukoplakia (OHL) is a viral infection of the oral cavity. Other HIV-related viral infections that can infect the area of the mouth include CMV, herpes simplex, varicella-zoster and papillomavirus. HIV-related infections of the mouth can also be fungal (i.e. candidiasis which, like OHL, is often one of the first opportunistic infections to appear and indeed it can be confused with OHL) or bacterial (which includes HIV gingivitis and HIV-related periodontal disease). Often OHL is one of the first indicators of HIV disease in patients who have not been tested for HIV the presence of OHL is diagnostic suggesting a seriously compromised immune system indicative of HIV infection, although OHL has also been seen:
    • in immunosuppressed organ transplant recipients (heart, bone marrow, kidney)

    11. EMedicine - Hairy Leukoplakia : Article By Hunter H Sams, MD
    hairy leukoplakia Oral hairy leukoplakia (OHL) is an oral mucosal disease thatfirst was described in 1984. hairy leukoplakia. Last Updated July 1, 2002,
    http://www.emedicine.com/med/topic938.htm
    (advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search Link to this site Back to: eMedicine Specialties Medicine, Ob/Gyn, Psychiatry, and Surgery Oncology
    Hairy Leukoplakia
    Last Updated: July 1, 2002 Rate this Article Email to a Colleague Synonyms and related keywords: oral hairy leukoplakia, OHL, AIDS, HIV, immunosuppression, immunocompromise AUTHOR INFORMATION Section 1 of 10 Author Information Introduction Clinical Differentials ... Bibliography
    Author: Hunter H Sams, MD , Staff Physician, Department of Internal Medicine, Division of Dermatology, Vanderbilt University Medical Center Coauthor(s): Alan Boyd, MD , Assistant Professor, Departments of Internal Medicine, Dermatology and Pathology, Vanderbilt University Hunter H Sams, MD, is a member of the following medical societies: American Academy of Dermatology , and American Academy of Family Physicians Editor(s): Sanjiv S Agarwala, MD , Associate Director, Melanoma Center, Associate Professor, Division of Medical Oncology, University of Pittsburgh Cancer Institute; Francisco Talavera, PharmD, PhD

    12. Hairy Tongue
    hairy tongue hairy leukoplakia. AIDS 10
    http://board.dserver.org/n/num5044/00000016.html

    13. EMedicine - Hairy Leukoplakia : Article Excerpt By: Hunter H Sams, MD
    hairy leukoplakia Oral hairy leukoplakia (OHL) is an oral mucosal diseasethat first was described in 1984. Excerpt from hairy leukoplakia.
    http://www.emedicine.com/med/byname/hairy-leukoplakia.htm
    (advertisement)
    Excerpt from Hairy Leukoplakia
    Synonyms, Key Words, and Related Terms: oral hairy leukoplakia, OHL, AIDS, HIV, immunosuppression, immunocompromise
    Please click here to view the full topic text: Hairy Leukoplakia
    Background: Oral hairy leukoplakia (OHL) is an oral mucosal disease that first was described in 1984. It is associated with Epstein-Barr virus (EBV) and occurs almost exclusively in patients who are immunocompromised, particularly those infected with HIV. Pathophysiology: Affected mucosa has diminished numbers of Langerhans cells and T-helper cells. Keratinocytes do not contain HIV, but EBV receptors have been detected in surrounding normal mucosa. Whether OHL develops after superinfection with EBV or activation of latent infection due to reduced immune surveillance is not known. Latent membrane protein-2 (LMP-2) may regulate reactivation from latency by interfering with normal B-cell signal transduction processes, which may be important for viral persistence. Multiple strains of EBV have been demonstrated in OHL lesions. Frequency:
    • In the US: Incidence of OHL in homosexual men and IV drug users who are infected with HIV is approximately 4%, but some evidence suggests that incidence is decreasing. The decreasing prevalence may be partially due to use of protease inhibitors. One study found that the 6-year incidence of OHL was 32% among 291 men in San Francisco who were HIV positive.

    14. Hairy Tongue Or Hairy Leukoplakia?
    I have fuzzy tongue disease. What is it? Hairy Tongue or hairy leukoplakia? My doctor has diagnosed me with fuzzy tongue disease.
    http://www.ivillagehealth.com/experts/ent/qas/0%2C11816%2C416906_175551%2C00.htm
    var cimsCid = ''; var cimsUid = '175551';
    main

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    15. Medical Considerations ORAL HAIRY LEUKOPLAKIA
    www.HIVdent.org, Medical Considerations CLINICAL MANAGEMENT OF THE HIVINFECTEDADULT Disease-Specific Protocols ORAL hairy leukoplakia. ORAL hairy leukoplakia.
    http://www.hivdent.org/medmid/middsp022.htm
    www.HIVdent.org Medical Considerations
    CLINICAL MANAGEMENT OF THE HIV-INFECTED ADULT
    Disease-Specific Protocols
    ORAL HAIRY LEUKOPLAKIA ORAL HAIRY LEUKOPLAKIA Definition: An oral infection caused by the Epstein-Barr virus, appearing as white, corrugated lesions on the lateral surfaces of the tongue. The infection may spread across the tongue's entire dorsal surface, onto the ventral surface, and may occasionally be found on buccal mucosa. S: Patient notices new, white lesions on the tongue which cannot be removed with a toothbrush. Pain is not associated with hairy leukoplakia infection. O: PE: Unilateral or bilateral white lesions on the margins, dorsal or ventral surface of the tongue or on buccal mucosa. The lesions may vary in appearance from smooth, flat, small lesions to irregular, "hairy" or "feathery" lesions with prominent folds or projections. LABS: HIV seropositivity documented. A: Rule out oral candidiasis, squamous cell carcinoma, and lichen planus. P: LABS/PROCEDURES:
  • Biopsy lesion only if it is unusual in appearance or ulcerated, to distinguish it from cancer or CMV.
  • 16. Hairy Leukoplakia
    hairy leukoplakia. Copyright © 19962000 Fred Ferguson,DDS Barbara Berentsen, RDH, MA. All Rights Reserved.
    http://www.hivdent.org/pediatrics/hairy_leukoplakia.htm
    Hairy Leukoplakia

    17. Oral Hairy Leukoplakia
    Ontario HIV Clinics' Fact Sheet. Oral hairy leukoplakia. What is it? Oral hairyleukoplakia is a white thickening or coating of the lining of the mouth.
    http://www.tthhivclinic.com/oralhair.htm
    INFORMATION ON HIV Go to other sections: Select a link HIV Overview/Stages of Infection The Life Cycle of HIV Disease Symptoms Fact Sheets Symptoms: Select a link Apthous Ulcers Candidiasis Cytomegalovirus (CMV) Cryptococcal Meningitis Cryptosporidiosis Herpes Zoster (Shingles) Histoplasmosis Kaposi’s Sarcoma Lymphoma Mycobacterium Avium Complex (MAC) Oral Hairy Leukoplakia PAP test/PAP smear and HIV paptest PAP test/PAP smear and HIV Peripheral Neuropathy Progressive Multifocal Leukoencephalopathy (PML) Toxoplasmosis (Toxo) Wasting Ontario HIV Clinics' Fact Sheet Oral Hairy Leukoplakia What is it? Oral hairy leukoplakia is a white thickening or coating of the lining of the mouth. It looks like white vertical folds or ridges. These ridges are almost always located on the sides of the tongue, although sometimes they can be found under the tongue or on the inside of the cheek. Oral hairy leukoplakia may look like oral candidiasis (thrush). Thrush can be scraped off. The white ridges of oral hairy leukoplakia do not scape off. Oral hairy leukoplakia occurs in people who have HIV and who have moderate to severe immune system damage. What do I look for?

    18. Oral Viral Lesion (Hairy Leukoplakia) Associated With Acquired Immunodeficiency
    Oral Viral Lesion (hairy leukoplakia) Associated with Acquired ImmunodeficiencySyndrome. From October 1981 to June 1985, 13 (11%) of
    http://www.cdc.gov/mmwr/preview/mmwrhtml/00000607.htm
    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.

    19. MEDLINEplus Medical Encyclopedia: Leukoplakia
    Alternative names hairy leukoplakia; Smoker's keratosis. hairy leukoplakiamay be one of the first signs of infection with the HIV virus.
    http://www.nlm.nih.gov/medlineplus/ency/article/001046.htm
    Skip navigation
    Medical Encyclopedia
    Other encyclopedia topics: A-Ag Ah-Ap Aq-Az B-Bk ... Z
    Leukoplakia
    Contents of this page: Alternative names Hairy leukoplakia; Smoker's keratosis Definition Return to top A precancerous lesion that develops on the tongue or the inside of the cheek as a response to chronic irritation. Occasionally, leukoplakia patches develop on the female external genitalia. Causes, incidence, and risk factors Return to top Leukoplakia is primarily a disorder of the mucous membranes of the mouth, caused by irritation. Lesions usually develop on the tongue, but they may appear on the insides of the cheek.
    Irritation may result from rough teeth or rough places on dentures, fillings, crown, and so on. It may also result from chronic smoking or other tobacco use (smoker's keratosis). Pipe smoking involves a high risk for development of leukoplakia, as does holding chewing tobacco or snuff in the mouth for a prolonged period of time.
    Occasionally, leukoplakia

    20. Oral Hairy Leukoplakia (OHL)
    Oral hairy leukoplakia (OHL). What is it? Oral hairy leukoplakia (OHL) refersto a white patch – or white patches – that can develop in the mouth.
    http://www.aidsmeds.com/OIs/OHL1.htm
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    Oral Hairy Leukoplakia (OHL)
    What is it?
    OHL can look like thrush , another common problem characterized by white patches that can develop in the mouths of HIV-positive people. However, thrush usually comes off when it is lightly scraped with a toothbrush, whereas OHL does not. OHL is often one of the first opportunistic infections to occur in HIV-positive people. It can occur at any T-cell count. HIV-positive people with more than 500 T-cells have developed OHL, but it is most common among HIV-positive people with fewer than 200 T-cells. It is also important to note that OHL can occur in people with healthy immune systems, including those not infected with HIV. It is considered to be a benign disease, meaning that it rarely causes serious physical problems and does not progress to more serious complications. OHL is caused by the Epstein-Barr virus (EBV). Most people in the world are infected with EBV. Only in some people, including those with compromised immune systems, does it cause disease.

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