Oral Hairy Leukoplakia as the First Oral Indicator of Depleted CD4 Count in HIV Patient

Winda Dwi Malinda Masuku1, Dian Angriany1, Diah Savitri Ernawati2, Desiana Radithia2

Oral Medicine Residency Program, Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia

Department of Oral Medicine, Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia



Objective: Oral Hairy Leukoplakia (OHL) is a disease associated with the infection of the oral epithelium by the Epstein-Barr virus, while typically associated with HIV infection and immunosuppression. HL has been used as a marker of disease activity since the lesion is associated with low CD4+ T-lymphocyte counts. Oral hairy leukoplakia is frequently encountered on the lateral borders of the tongue. The typical clinical appearance is of vertical white folds aligned as a palisade along the border of the tongue. The lesions may also appear as awhite elevated plaque, which cannot be scraped off. Oral hairy leukoplakia is asymptomatic, although symptoms may be present when the lesion is superinfected with candidal strains.


Case: A 32-year-old male came to Oral Medicine Clinic of Airlangga University Hospital complaining of thickening, warmth and pain from the tongue and oral cavity for the preceding three months- the patient had difficulty in eating and had lost 10 kg in weight over the last three months. He had been diagnosed with tuberculosis two years ago, had been treated with TB therapy for six months before being declared cured. Intraoral examination found white patches on the lateral border of the tongue, white pseudomembranous plaques were visible on the dorsum of the tongue, the bucal muccosa and oropharynx.

Methods: complete blood count, Anti-HIV test and KOH test.


Results: the result of several test including anti-HIV showed reactive results, CD4 examinations were obtained with a total of 50 cells, KOH test showed positive results and cultured test found Candida albicans species. Nystatin oral suspension was prescribed  for two weeks, the patient also receive therapy from an internist and pulmonary specialist and showed significant changes to his perceived complaints.


Conclusion: Oral Hairy Leukoplakia can be used as the first iirst oral indication of a depleted CD4 Count in HIV patients.


Keywords: HIV/AIDS, Oral Hairy Leukoplakia, Candidiasis, Tuberculosis