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de Faria PR, Vargas PA et al. Oral Diseases 2005; 11: 72–80

Oral disease is sometimes the first indication of HIV infection. This is more apparent in developing countries. This paper from Brazil reports the results of macroscopic and microscopic tongue examination at autopsy of 62 male and 30 female patients. In 65 patients for whom data was available, the mean of the last CD4 count before death was 82 ± 115 cells/μL. The main causes of death were mycobacteriosis (29%) and septic shock (23%).

Histological tongue lesions were found in 75% of patients; 42% were lateral, 26% anterior, 17% medial and 15% posterior. Hairy leucoplakia affected 46%, candidosis, 34%, and in one subject an Epstein-Barr virus positive B-cell non-Hodgkins lymphoma was present. Other less common presentations were described as herpes simplex and cytomegalovirus lesions.

The authors comment that there was frequent non-specific ulceration and glossitis, and suggest that the tongue is a frequent site for end-stage lesions in AIDS.