AEGiS-11IAC: Role of podophyllin resin therapy in oral hairy leukoplakia in HIV infection: clinicopathologic study.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Role of podophyllin resin therapy in oral hairy leukoplakia in HIV infection: clinicopathologic study.

Int Conf AIDS 1996 Jul 7-12; 11:298 (abstract no. Th.B.4274)
Nichols CM, Flaitz CM, Hicks MJ; Bering Dental Clinic, Houston, TX. Fax: 713-524-7995.

OBJECTIVE: To evaluate podophyllin resin (PR) treatment on oral hairy leukoplakia (HLP) in HIV-seropositive individuals with respect to degree of resolution, number of treatments required, recurrence rate and interval, and refractory lesions.

METHODS: Fifty-two HIV-seropositive individuals (51M:1F; 34W, 13H, 5B; mean age 36yrs; mean CD4=141; 50 MSM, 1 transfusion, 1 heterosexual) with 110 HLP lesions were included in the study. Cytology/biopsy was performed in 40 of 52 patients. HLPs were characterized by type (flat, corrugated), extent (mild, moderate, severe), site (bilateral/lateral ventrolateral tongue, dorsum of tongue, buccal mucosa, floor of mouth) and duration. HLPs were treated topically with PR until resolution or no clinical reduction in lesion size. Patients were followed for up to 2 years (mean 21 wks) and evaluated for HLP recurrence. Clinical data (medications, opportunistic infections, sexually transmitted diseases) were also reviewed.

RESULTS: Lesion sites were bilateral (72%) and unilateral (9%) ventrolateral tongue, dorsal tongue (13%), buccal mucosa (5%) and floor of mouth (1%). Corrugated HLPs (89%) were more common than flat HLPs (11%). Extent of HLP lesions was assessed as mild (37%), moderate (46%) and severe (17%). Mean duration of the HLPs was 25wks (range 4-156wks). Initial symptoms were present in only 15% of individuals (pain, change/loss of taste). Acyclovir was taken by 27% of patients. Mean number of PR treatments was 2.2 (range 1-8). Complete resolution of HLPs occurred in 78%. Mean reduction in lesion size was assessed to be 92%, with 84% of lesions having a reduction in size of greater than or equal to 95%. HLPs (8%) refractory to treatment had a mean size reduction of 24%. Two of five refractory HLPs resolved with laser therapy. HLP recurrence developed in 17% (mean interval 17wks, range 1-104wks). Remaining HLPs (83%) required no further treatment (mean followup 21 wks). Side-effects (change/loss of taste, allergic reaction, pain, dysphagia) from PR occurred in 13%.

CONCLUSIONS: Podophyllin resin treatment induces HLP resolution (78%) and a significant reduction in lesion size (92%). Some HLPs are refractory to podophyllin resin therapy. A certain proportion of HLPs will recur several months after PR treatment and may require re-treatment with podophyllin resin.

Keywords: AEGIS, Leukoplakia, Hairy, Podophyllin, HIV Infections, HIV Seropositivity, Resins, Plant, Tongue, Mouth Mucosa, Blood Transfusion, Tongue Neoplasms, Human, therapy, ICA11

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ThB4274