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OHL EBV No Treatment — SCE Infectious Diseases MCQ

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EasyHIV MedicineOHL EBV No TreatmentSCE Infectious Diseases

A 30-year-old man with HIV develops new oral hairy leukoplakia (OHL) — white corrugated plaques on the lateral tongue margins that cannot be scraped off. He is on effective ART (CD4 380, VL <50). What causes OHL and does it require treatment?

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Correct answer: A — EBV — OHL is caused by EBV replication in the tongue epithelium; it is generally benign and does NOT require treatment in asymptomatic patients; it may resolve with ART-mediated immune reconstitution

OHL is caused by EBV replication in the squamous epithelium of the tongue lateral margins. It presents as white, corrugated, 'hairy' plaques that CANNOT be scraped off (distinguishing it from oral candidiasis which CAN be scraped). OHL is generally benign and asymptomatic — treatment is NOT routinely required. It may resolve spontaneously with ART. If symptomatic or cosmetically bothersome: topical Podophyllin resin, oral Valaciclovir, or topical retinoids. OHL is an indicator of immune dysregulation but is NOT pre-malignant.

Reference: BHIVA 2022 – Oral conditions in HIV; NICE CKS 2024