OHL HIV Management — ORE Part 1 MCQ

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EasyOral MedicineOHL HIV ManagementORE Part 1

A patient with controlled HIV infection (CD4 count above 200 cells/mm³ and an undetectable viral load) has a typical corrugated, non-scrapable white lesion on the lateral border of the tongue, diagnosed clinically as oral hairy leukoplakia. What is the most appropriate management?

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Correct answer: C — Provide reassurance and review routinely

The correct answer is C. Oral hairy leukoplakia is an Epstein–Barr virus-associated lesion that typically affects the lateral tongue in immunosuppressed people, including those with HIV. It is benign and, unlike conventional oral leukoplakia, is not a potentially malignant disorder; a typical lesion therefore does not require urgent biopsy or an urgent cancer referral. Antiviral or local treatment may sometimes be used, but this is not an urgent requirement and is generally reserved for troublesome or cosmetically unacceptable lesions. Although oral hairy leukoplakia can be associated with immunosuppression, its occurrence alone in a patient with documented viral suppression does not establish antiretroviral treatment failure. Biopsy or specialist assessment would be appropriate only if the appearance were atypical or the diagnosis uncertain.

Reference: NHS, Leukoplakia—"Hairy leukoplakia" section, updated 2023, https://www.nhs.uk/conditions/leukoplakia/