Muhammad Al Farisyi1, Irna Sufiawati2
Oral Medicine Residency Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
Oral Medicine Departement, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
Objective: Epstein-Barr virus (EBV) is an etiological agent of oral hairy leukoplakia (OHL) and is recognised as a lesion strongly associated with HIV infection.
The diagnosis of OHL is usually made based on clinical findings, but detection of EBV DNA in saliva has proven useful for early diagnosis of EBV reactivation and monitoring EBV-related diseases. We present three cases of OHL diagnosis established by EBV DNA detection in saliva of HIV patients.
Method: Three HIV-infected patients came to Oral Medicine Clinic with similar complaints of asymptomatic white lesions on the tongue. The first patient was a 35-year-old treatment-na1ve HIV-infected woman with CD4 counts 115 cells/mm3, and the second patient was a 23-year-old treatment-na1ve HIV-infected man with CD4 count 303 cells/mm3. The third patient was a 29-year-old HIV-infected woman receiving ART with CD4 counts 241 cells/mm3. Intraoral examination revealed white plaques with irregular surface on the lateral border of the tongue, which could not be removed by scraping. A removable white curd-like plaque was also found on the dorsum of the tongue leaving erythematous underlying surface in the first patient. All patients were diagnosed with suspected OHL, and oral thrush in the first patient. A multiplex RT-PCR DNA microarray was performed to detect EBV DNA in saliva collected by spitting method. All patients showed positive results for EBV DNA, the definitive diagnosis of OHL was made. Resolution of lesions at 1-2 months follow-up after treatment with application of acyclovir 5% cream 5 times daily, and antifungal was also given to the first patient and the initial ART to the first and second patients.
Conclusion: EBV spread mostly by asymptomatic shedding into saliva, therefore the detection of salivary EBV DNA is useful in establishing a definitive diagnosis of OHL allowing more effective treatment for both HIV-infected patients receiving ART and treatment-na1ve patients at any CD4+ count.