[Final Program, International Conference on AIDS (4th: 1988: Stockholm, Sweden), Book 2]

7581 EBV IN ORAL HAIRY LEUKOPLAKIA, AN
ELECTRON MICROSCOPIC IMMUNOCYTOCHEMICAL STUDY.
J.S. Greenspan, V. Petersen, Y. De Souza and D. Greenspan.
Oral AIDS Center, University of California, San Francisco,
San Francisco, CA.
Objective. To accurately localize EBV components, to study
the life-cycle of EBV and develop additional methods for
confirmation of its presence in oral hairy leukoplakia (HL).
Methods. EM immunocytochemistry was applied to 10
paraformaldehyde-fixed biopsy specimens of tongue HL and
uninvolved buccal mucosa from the same patients. Etched
sections of epoxy-embedded samples were labelled in a two
step reaction using monoclonal antibodies to EBV-VCA and
gold colloid conjugated to goat anti-mouse IgG-Fab2 purified
fragment. Results. Reaction product was localized to the
capsids of virus particles within ballooning and adjoining
epithelial nuclei as well as within intercellular spaces in HL
lesions. Ascites fluid in place of monoclonal antibody was a
negative control, as was buccal mucosa.
Conclusion. EM immunocytochemistry of EBV in HL confirms
light-microscope findings and offers an approach to
understanding the biology of EB infection of epithelial cells.

7582 EARLY ORAL LESIONS FOUND IN COMMUNITY
COHORTS: IS HAIRY LEUKOPLAKIA MORE COMMON THAN CANDIDIASIS? David W Feigal, GL Overby,
D Greenspan, JS Greenspan and the UCSF Oral AIDS Epidemiology Group
+. University of California, San Francisco. USA.
Objective: To determine the incidence and prevalence of early oral lesions in
HIV infected individuals.
Method: Since January 1987, six prospective cohort studies agreed to systematically examine and record oral lesions. As part of routine physical examinations, usually at 6 month intervals, 418 lesions were observed in 1514
patients. Results: 72% of lesions were white, usually flat or corrugated
predominantly hairy leukoplakia. (HL) The number of prevalent lesions
(present on first exam after oral examination training) and incident lesions
(absent on initial examination) is shown by cohort and compared to the
Oral Medicine Clinic.

HL
n Prev. Incid.

Candidiasis
Prev. Incid.

AWARE 58
SF Epi Group 241
City Clinic 287
Men's Health 771
Transf.Safety......13.7
TOTAL 1494
Oral Med Clinic 273

4
33
21
66.........5...,
5
129
138

3
16
15
24
5
63
69

0
0
0
1
0
1
7

1
14
18

Conclusions: Hairy leukoplakia, in part because of its longer duration than
candidiasis, is likely to be the most often detected early oral manifestation
of HIV infection.
+ W. Winkelstein, A Moss, GW Rutherford, C Wofsy, EA Donegan, R Chaisson

Notes:

7583 ORAL HAIRY LEUKOPLAKIA
Angelika A. Langford*, J Becker*, P Reichart*, H
Gelderblom**, X Zhang**, T Lning***, H Wolf#
*Dept. for Oral Surgery (North), Free University Berlin,
**Robert Koch-Institute, Berlin, *** Inst. for Pathology,
University Hamburg, # Max von Pettenkofer Institute, Munich
Clinical, immunhistochemical and ultrastructural findings.
70 cases of oral hairy leukokplakia (HL), occuring in 61
homosexual men, 8 i.v. drug abusers and one hemophiliac
child, were clinically examined and followed up during an
average time of observation of 13.5 months. All lesions
were localised on the lateral and/or ventral side of the
tongue.
In order to evaluate, if EBV-DNA can be found only in HL
of HIV-infected patients, biopsies of HL, of uninvolved oral
mucosa and of oral Kaposi sarcoma were examined. Using
in situ hybridisation techniques 5/6 biopsies of HL and 2/24
biopsies of oral gingiva showed EBV-DNA. In a further in
situ hybridisation all EBV-DNA positive specimens were
negative for CMV-DNA as well as with the applied probes
of human papilloma virus type 6, II, 13, 16 and 18.
By means of immunohistochemistry (APAAP) io biopsies
were examined for EBV-membrane, -core and early protein
pI50. An equivalent immunostaining was noted in the upper
two thirds of oral epithelia.
The clinical importance of reactivation of latent EBVinfection in HIV-infected patients and the role of cytotoxic
T-lymphocytes for elimination of EBV-infected cells are
discussed.

7584 ULTRASTRUCTURAL FINDINGS IN CLINICALLY
UNINVOLVED ORAL MUCOSA OF PATIENTS
WITH HIV-INFECTION
Xiaolin Zhang*, A Langford**, H Gelderblom*,
P Reichart**
*Robert Koch-Institute, Berlin; **Dept. for Oral Surgery
(North), Free University Berlin
Objective. To compare ultrastructural changes of uninvolved
oral mucosa of patients infected by HIV with those observed
in oral Kaposi's sarcoma (AIDS) (KS) and to discuss the
pathogenesis of oral KS.
Methods. Biopsies of clinically uninvolved oral mucosa of 12
patients with HIV-infection (average age 34,7 yrs; male:
n=Io, female: n=2; asymptomatic: n=4, ARC: n=3, AIDS:
n=5, including 2 patients with KS) were studied by EM and
compared to those seen in typical AIDS related KS lesions.
Results. Vascular abnormalities were found in all biopsies of
the HIV-infected patients regardless of the stage of the
disease. In particular, protruded swollen endothelial cells
were observed. Vascular channels reduced to a slit as well
as a sparseness of intercellular junctions were found.
Vascular walls were often revealing gaps and slits. There
was an increase in quantity of Weibel-Palade bodies within
the cytoplasm. Occasionally, extravasated erythrocytes were
observed. These findings were similar to those described in
early and late KS lesions. Comparable changes could not be
observed in oral mucosa of uninfected individuals.
Conclusion. The present EM findings in uninvolved oral
mucosa suggest that blood vessels during HIV-infection
undergo changes which probably involve the entire vascular
system. Therefore, a general principle either represented by
specific angiogenic factors or viral infections serve as
primers of the disregulation of vascular neogenesis.

320