An HIV-positive patient on ART with undetectable viral load develops oral hairy leukoplakia (OHL) on the lateral tongue. Biopsy shows koilocytes. PCR confirms EBV in lesional tissue. This condition is associated with which EBV product specifically driving epithelial cell proliferation in OHL?

• A Productive (lytic) EBV replication rather than latent infection — early antigen (EA) and viral capsid antigen (VCA) are expressed in the epithelial cells ✓
• B EBNA-2 (Epstein-Barr nuclear antigen 2) driving cellular transformation via Notch pathway activation
• C Lytic cycle replication with EBV-encoded latent membrane protein LMP1 driving NF-κB
• D EBV-encoded microRNA miR-BART2 blocking apoptosis in squamous epithelium

Explanation

Oral hairy leukoplakia is a unique condition caused by productive (lytic) EBV replication in superficial squamous epithelial cells of the lateral tongue. Unlike EBV-associated malignancies (where latency programs with EBNA-2 and LMP1 predominate), OHL features active viral replication with expression of EA, VCA, and viral structural proteins — explaining the presence of koilocytes and viral particles on electron microscopy. This lytic replication occurs preferentially in immunosuppressed hosts (HIV, transplant recipients). Treatment with high-dose acyclovir or valacyclovir (which blocks lytic replication) resolves OHL, confirming the lytic mechanism.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.