Oral hairy leukoplakia (OHL) refers to a white patch – or white patches – that can develop in the mouth. These patches usually occur along the sides of the tongue, although they can sometimes develop on the top and underside of the tongue or along the inside of the cheek. Looking carefully at these patches, they may appear shaggy or may contain a number of tiny folds or ridges.
OHL can look like thrush, another common problem characterized by white patches that can develop in the mouths of HIV-positive people. However, thrush usually comes off when it is lightly scraped with a toothbrush, whereas OHL does not.
OHL is often one of the first opportunistic infections to occur in HIV-positive people. It can occur at any T-cell count. HIV-positive people with more than 500 T-cells have developed OHL, but it is most common among HIV-positive people with fewer than 200 T-cells. It is also important to note that OHL can occur in people with healthy immune systems, including those not infected with HIV.
It is considered to be a benign disease, meaning that it rarely causes serious physical problems and does not progress to more serious complications.
OHL is caused by the Epstein-Barr virus (EBV). Most people in the world are infected with EBV. Only in some people, including those with compromised immune systems, does it cause disease.
More than 25% of HIV-positive people develop OHL at some point during the course of their infection. It is most common among HIV-positive men and smokers.