Persistent OHL Differential — NDEB AFK MCQ

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ModerateOral PathologyPersistent OHL DifferentialNDEB AFK

Oral hairy leukoplakia that does not resolve after antiretroviral therapy initiation should raise suspicion for which additional diagnosis?

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Correct answer: C — Oral candidiasis superimposed on hairy leukoplakia

Oral hairy leukoplakia (OHL) is caused by EBV replication in the superficial epithelium and typically responds to improved immune function with antiretroviral therapy. If the white patches persist despite adequate virological suppression, superimposed oral candidiasis should be considered (the two conditions can coexist). A trial of antifungal therapy may resolve the persistent component. If white plaques persist after both ART and antifungal therapy, biopsy should be considered to exclude other pathology (leukoplakia, SCC).

Reference: Neville – Oral and Maxillofacial Pathology, 4th ed., 2016