Systemic Acyclovir Research Articles

Focal Posterior Pole Viral Retinitis

To describe the clinical features of an atypical form of viral retinitis in immunocompetent patients. This was a retrospective noncomparative case series. The charts of 8 patients diagnosed with and treated for focal posterior viral retinitis were reviewed. Clinical and demographic features were evaluated. All the patients had extensive laboratory tests, fundus fluorescein angiography, optical coherence tomography of macula, and polymerase chain reaction of vitreous. All the patients were referred to our Uveitis Service from other hospitals, as their uveitis symptoms deteriorated in spite of treatment. The mean age of 4 male and 4 female patients was 32.1 years (range, 22-42 years). The mean follow-up period was 10 months (range, 6-18 months). All of the patients had unilateral disease. Polymerase chain reaction analysis of vitreous specimen was positive for herpes simplex virus-1 in 5 patients and varicella zoster virus in 3 patients. Retinitis resolved after systemic acyclovir treatment in all patients. Viral etiology must be borne in mind in the differential diagnosis of atypical retinitis. It can be a milder form of viral retinitis like focal viral retinitis, as mentioned in this study. The prognosis of this disease is better than the other forms of necrotizing retinopathies involving a larger area of retina.

Unilateral acute retinal necrosis in a multiple sclerosis patient treated with high-dose systemic steroids

A 50-year-old man with multiple sclerosis developed unilateral acute retinal necrosis following a long-term systemic corticosteroid administration for treatment of an attack of paraparesis. The patient was treated with systemic acyclovir, aspirin, oral steroids and topical cyclopentolate and prednisolone acetate for almost 3 months. Pars plana vitrectomy and 360° endolaser photocoagulation posterior to necrotic retinal areas were performed a week after the initial diagnosis. Varicella zoster DNA was confirmed by PCR analysis in the vitreous sample. Two months later, pars plana vitrectomy with silicone oil injection was performed successfully to treat complicated retinal detachment. Careful peripheral fundus examination is essential when acute unexplained visual loss is noted in patients receiving systemic corticosteroids to exclude acute retinal necrosis syndrome.

Recurrent Herpes Simplex Keratitis After Verteporfin Photodynamic Therapy for Corneal Neovascularization

To report a case of recurrent herpes simplex keratitis after verteporfin photodynamic therapy for corneal neovascularization. A 69-year-old man who had lipid keratopathy with corneal neovascularization secondary to herpes simplex keratitis in the right eye and who was treated with topical steroid received photodynamic therapy with verteporfin. Six neovascular areas in the cornea were treated consecutively to occlude new vessels and reduce the risk of allograft rejection after subsequent keratoplasty. Three days after verteporfin photodynamic therapy, there was evidence of vascular occlusion. However, a herpetic epithelial ulcer was detected in the cornea. Ten days after treatment, the lesion progressed to a geographic ulcer. After topical and systemic acyclovir treatment, the lesion healed. Five months after treatment, penetrating keratoplasty and postoperative antiviral prophylaxis were performed. During a follow-up period of 12 months, the graft remained clear with visual acuity of 20/40. Herpes simplex keratitis can recur after verteporfin photodynamic therapy for corneal neovascularization.

Intravitreal Foscarnet Therapy for Acyclovir-Resistant Acute Retinal Necrosis After Herpes Simplex Encephalitis.

The development of acute retinal necrosis (ARN) is not uncommon among individuals with a history of herpes simplex encephalitis, as the virus may be capable of transport via axonal cells to the neuroretina. Though it is known that ARN severely threatens vision, timely initiation of effective therapy can help save a patient's vision and retina. In this case report, clinical resistance to acyclovir was found. Subsequent treatment with intravitreal foscarnet resulted in immediate clinical improvement. This case suggests that patients with acute retinal necrosis can be considered for treatment with intravitreal foscarnet in the setting of systemic acyclovir resistance.

A rare case of orbital apex syndrome with herpes zoster ophthalmicus in a human immunodeficiency virus-positive patient

We report a rare instance of favorable outcome in orbital apex syndrome secondary to herpes zoster ophthalmicus (HZO) in a human immunodeficiency virus (HIV)-positive patient. The patient complained of pain and decrease in vision in one eye (20/640) for 2 weeks accompanied with swelling, inability to open eye, and rashes around the periocular area and forehead. The presence of complete ophthalmoplegia, ptosis, relative afferent pupillary defect, and anterior uveitis with decreased corneal sensation prompted a diagnosis of HZO with orbital apex syndrome. The enzyme-linked immunosorbent assay test and a low CD4 count confirmed HIV. Highly active antiretroviral therapy (HAART), systemic acyclovir, and systemic steroids were started. Visual acuity and uveitis improved within 10 days. By the end of the fourth week, ocular motility also recovered and the final visual acuity was 20/25. We highlight the role of HAART, used in conjunction with systemic steroid and acyclovir therapy, in improving the outcome.

Síndrome do ápice orbitário causada por herpes zóster oftálmico: relato de caso e revisão da literatura

O Herpes Zoster Oftalmico (HZO) decorre da infeccao pelo virus da varicela-zosterque permanece latente no gânglio de Gasser ate que seja reativado e comprometa adivisao oftalmica do nervo trigemeo. HZO frequentemente causa manifestacoesoftalmologicas como lesoes vesiculares palpebrais, ceratoconjuntivite, esclerite, uveite,paralisia oculomotora, miosite orbitaria e neurite optica. Raramente o acometimentodo apice da orbita pode ser a manifestacao inicial desta grave afeccao. Este trabalhorelata um caso de sindrome do apice orbitario associado a meningite, causado por HZOe que foi tratado com corticosteroide e aciclovir sistemicos.

Cochrane review: Acyclovir for treating primary herpetic gingivostomatitis

AbstractBackgroundPrimary herpetic gingivostomatitis is a highly contagious infection of the oral cavity which typically affects children but can also occur in adults. Symptoms may vary widely from mild discomfort to life‐threatening encephalitis.ObjectivesThe objective of this review was to evaluate the effectiveness of systemic acyclovir for primary herpetic gingivostomatitis.Search strategyWe searched the following databases: Cochrane Oral Health Group's Trials Register (to 22 May 2008); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 2); MEDLINE (1950 to 22 May 2008); and EMBASE (1980 to 22 May 2008). There were no language restrictions.Selection criteriaRandomised controlled trials comparing acyclovir to placebo in children and young adults < 25 years of age with a diagnosis of primary herpetic gingivostomatitis with or without herpes labialis were considered.Data collection and analysisTwo review authors independently and in duplicate screened and extracted information from, and assessed the risk of bias in the included clinical trials. The Cochrane Collaboration statistical guidelines were followed for data synthesis.Main resultsOnly two clinical trials, one with 72 participants and the other with 20 participants were included in this review. The second study failed to report several methodological items and was inconsistent in its reporting of the outcomes measurement.The first trial, with a moderate risk of bias, showed better results in the acyclovir group compared to the placebo group in children < 6 years of age in reducing the number of individuals with oral lesions (risk ratio (RR) 0.10 (95% confidence interval (CI) 0.02 to 0.38)), new extraoral lesions (RR 0.04 (95% CI 0.00 to 0.65)), difficulty in eating (RR 0.14 (95% CI 0.03 to 0.58)), and drinking difficulties (RR 0.11 (95% CI 0.01 to 0.83)) after 8 days of treatment.Following the onset of treatment, three patients from the placebo group were admitted to hospital for rehydration (P = 0.11).Four children (two from the acyclovir, and two from the placebo group) showed mild gastrointestinal symptoms that resolved spontaneously after 24 to 48 hours without a change in the study treatment.Authors' conclusionsWe found two relevant trials in this systematic review, only one of them could provide some weak evidence that acyclovir is an effective treatment in reducing the number of oral lesions, preventing the development of new extraoral lesions, decreasing the number of individuals with difficulties experienced in eating and drinking and reducing hospital admission for children under 6 years of age with primary herpetic gingivostomatitis.Plain Language SummaryAcyclovir for treating primary herpetic gingivostomatitisThere is some weak evidence that acyclovir can be an effective treatment in decreasing some of the symptoms caused by primary herpetic gingivostomatitis.Primary herpetic gingivostomatitis is a highly contagious infection of the oral cavity which is caused by the herpes simplex virus. It is prevalent in children and young adolescents and sometimes can cause uncomfortable symptoms including eating and drinking difficulties and even life‐threatening inflammation of the brain (encephalitis).This review included two trials (92 participants) but only one of them provided some limited evidence to suggest that acyclovir is an effective treatment in reducing the number of oral lesions, preventing the development of new extraoral lesions, decreasing the number of individuals with difficulties experienced in eating and drinking and of those who are admitted to hospital for children under 6 years of age with primary herpetic gingivostomatitis.

Superior orbital fissure syndrome in herpes zoster ophthalmicus

To report a case of superior orbital fissure syndrome (SOFS) in a patient with herpes zoster ophthalmicus (HZO). A case report. A 71-year-old male with HZO presented acutely to accident and emergency complaining of right vision loss, double vision and drowsiness. The right visual acuity was counting fingers. There was no relative afferent pupillary defect. He had interstitial keratitis, ptosis, proptosis and total ophthalmoplaegia. The signs indicated HZO complicated by SOFS. Brain imaging and lumbar puncture confirmed the diagnosis of varicella zoster encephalitis. Systemic acyclovir and prednisolone led to recovery of visual acuity and ocular motility in addition to resolution of his proptosis and ptosis. SOFS is a rare complication of herpes zoster infection. With the appropriate treatment and follow-up, patients may be reassured that recovery of their visual acuity and ocular motility will occur.

Herpes Zoster Keratouveitis and Inflammatory Ocular Hypertension 8 Years After Varicella Vaccination

More than 8 years after varicella vaccination, a healthy 16 year-old boy presented with keratouveitis, severe inflammatory glaucoma in his left eye, and Hutchinson's sign. He was treated with systemic acyclovir, topical steroids, cycloplegics, and glaucoma medications for a full recovery two months after presentation. It is unclear whether the source of herpes zoster which reactivated in this patient represents wild type virus or his previous vaccine strain. Herpes zoster ophthalmicus is very rare in the pediatric population after varicella vaccination but can cause severe inflammatory glaucoma that requires aggressive therapy.

Herpes zoster infection after liver transplantation in patients receiving induction therapy with alemtuzumab

The incidence of herpes zoster (HZ) infection in liver transplant recipients prior to the use of induction therapy with monoclonal antibodies has been reported as being 1.2-18%. We studied the occurrence of HZ in liver transplant recipients that received induction therapy with alemtuzumab (Campath 1H). This was a retrospective review of primary liver transplant recipients who received alemtuzumab as induction therapy at our center. HZ infection was diagnosed clinically as the presence of a characteristic vesicular rash in a dermatomal distribution without any further virological confirmation. A total of 118 liver transplant recipients were treated with alemtuzumab between August 2002 and August 2005. Twelve patients developed HZ infection, and the cumulative probability of a patient developing HZ infection by 36 months post-transplant +/-1 SE was estimated as 16.5 +/- 5.0%. The median time for onset of the infection was 10.2 months (range 4.7-30.7) after the transplant. All patients had only one dermatomal distribution, and none developed systemic infection or complications such as postherpetic neuropathy. All patients except one were treated with systemic intravenous acyclovir. One patient received famciclovir. All of the patients had received ganciclovir during the post-transplant period but were not receiving any other antiviral medication at the time of the infection. Herpes zoster infection has previously been reported as a frequent complication of liver transplantation. Our study suggests that it occurs in approximately 16% of patients receiving induction therapy with alemtuzumab. Although alemtuzumab is a powerful immunosuppressive agent and there is still little information regarding its long-term safety when used in liver transplantation, our data do not suggest any increase in the occurrence and complications of HZ.

Acyclovir Therapy in Prevention of Recurrent Herpetic Keratitis Following Penetrating Keratoplasty

To compare systemic vs topical acyclovir therapy for the prevention of recurrence of herpetic keratitis following penetrating keratoplasty (PK). A retrospective observational study. Patients who underwent PK for herpetic eye disease (HED) and prophylactically received acyclovir therapy postoperatively, either systemically (26 eyes) or topically (29 eyes), were analyzed. The main parameters evaluated were recurrence of herpetic keratitis, graft rejection, visual acuity, and graft survival rate. Mean average follow-up period was 24.7 +/- 3.6 months and 23.5 +/- 2.3 months in the systemic and topical group, respectively (P = 0.73). The average duration of prophylactic antiviral therapy in systemic group was 16.1 +/- 4.8 months and in topical group was 15.1 +/- 3.5 months (P = .59). Recurrence of herpetic keratitis was seen in 12% in the systemic group compared to 55% in the topical group (P < .001). More eyes in topical group 15 (52%) had rejection episodes than in the systemic group 5 (19%) (P < .001). A best-corrected visual acuity of > or = 20/40 was achieved in 31% and 7% eyes in the systemic and topical group, respectively, at the end of two years (P = .002). The clear graft survival rate in the systemic and topical acyclovir receiving group was 96.2% vs 86.2% at 12 months, and 88.5% vs 65.5% at 24 months, respectively. Systemic acyclovir is more effective than topical acyclovir in achieving better graft outcomes after PK for HED.

Varicella chorioretinitis

A 17-year-old man presented with a history of floaters and blurred vision for a month. He was also suffering from a typical varicella infection during this month. The typical signs and symptoms of chickenpox had already subsided, except a few crusted eruptions on his abdomen that remained at the time of our examination. Visual acuity was 6/10 in the right eye and 10/10 in the left. There was 1+ ciliary injection in the right eye. No cells were detected in the anterior chamber, and the cornea was normal. There were 2+ vitreous cells in the right eye. Fundus examination revealed an active yellow-white focus of chorioretinitis on the distal end of inferotemporal retinal vein (Fig. 1). The left eye was normal. Active yellow-white focus of chorioretinitis on the distal end of inferotemporal retinal vein. We prescribed topical steroids and oral acyclovir 200 mg five times a day and fluocortolone 60 mg a day for 6 weeks. Four weeks later, the patient’s visual acuity had recovered to 10/10 in the right eye. At the end of the sixth week, oral corticosteroids were tapered and acyclovir was stopped. On a follow-up examination 3 months after diagnosis, his visual acuity in the right eye remained 10/10 and no vitritis was detected. A sharply demarcated chorioretinal atrophy was seen and no retinal tear was found in the fundus examination (Fig. 2). The fellow eye was completely normal. A sharply demarcated chorioretinal atrophy area after treatment. Varicella zoster is a frequent cause of human infection, producing chickenpox in children and herpes zoster in adults. Varicella can cause acute retinal necrosis in otherwise healthy individuals of both sexes and any age. Ocular manifestations of the congenital varicella-zoster syndrome are well-known (Lambert et al. 1989; Mendivil et al. 1992). Varicella infection in an adult rarely causes serious ocular complications but may be complicated with chorioretinitis. Kelly & Rosenthal (1990) described chickenpox chorioretinitis in an adult. The lesions involved 360° of the peripheral fundus and they treated the patient with topical steroids and oral acyclovir 200 mg four times daily. Because the chorioretinitis we described was located in the posterior pole and near to the macula, we decided to treat our patient with systemic steroids and acyclovir 2 g daily besides topical steroids. Matsuo et al. (1988) described acute retinal necrosis following chickenpox, which progressed gradually toward the posterior pole. The patient was treated with prednisolone and intravenous acyclovir. We decided not to treat with intravenous medication because by the time the patient referred to our department, in spite of its posterior pole location, the lesion was still well-demarcated and no other foci were around. Also, the fellow eye was completely normal. In a small number of cases, chickenpox infection can cause vision-threatening chorioretinitis, which may be located at the posterior pole or peripheral fundus. Varicella is a fairly frequent cause of usually mild, self-limiting irididocyclitis in children. All varicella patients with visual symptoms must be examined carefully with respect to ocular complications. Also, progressive acute retinal necrosis associated with Varicella zoster is not uncommon in AIDS.

The use of nerve growth factor in herpetic keratitis: a case report

BackgroundWe evaluate the role of nerve growth factor (NGF) eye drops to treat a herpetic corneal ulcer resistant to systemic and local acyclovir treatment in an HIV-positive patient.Case PresentationA 68 year old HIV-positive male presented with a herpetic corneal ulcer which was treated unsuccessfully with acyclovir. Acyclovir sensitivity of herpes simplex virus was tested with a dye uptake assay and we found that the herpes simplex virus isolated was resistant to acyclovir. We started eye drop therapy with NGF and the corneal herpetic ulcer healed in 23 treatment days.ConclusionThe case presented here is the first described in the literature in which a herpetic corneal ulcer was successfully treated with NGF. We recommend that trials of NGF therapy in herpetic keratitis should be carried out on a larger number of acyclovir resistant cases.

Maxillary Herpes Zoster with Corneal Involvement in a HIV Positive Pregnant Woman

Corneal involvement in maxillary herpes zoster is very rare. This report presents the case of a 32 years old 7 months pregnant para2+1 female, who presented with vesiculopapular rashes with hyperpigmented crusts over the maxillary area of the face on the left side with periocular oedema, conjunctivitis and mild punctate keratitis in the left eye. She was HIV positive and was on treatment with the highly active antiretroviral therapy. She was treated with topical and systemic acyclovir with rapid resolution of the ocular features.

Retinal Detachment in Patients with Acute Retinal Necrosis: A Case Series

Acute retinal necrosis is a rare and severe infectious ocular disease frequently complicated by retinal detachment. Records of six consecutive eyes from five patients with acute retinal necrosis were reviewed. PCR analysis of intraocular fluids was positive for Varizella zoster virus, Herpes virus 1 or 2. Treatment consisted of systemic acyclovir, systemic and local corticosteroids as well as aspirin. Progression of the necrosis could be effectively controlled, however all eyes developed retinal detachment within 55 +/- 24 days. Retinal surgery including pars plana vitrectomy, encircling scleral buckling, liquid silicone or gas filling led to retinal reattachment in all patients during the follow-up time (590 +/- 242 days). The mean visual acuity at the end of the follow-up time was 0.4 +/- 0.3. The diagnosis of acute retinal necrosis is reliably confirmed using PCR analysis of intraocular fluids. Currently available treatments are effective in stopping progression of the necrosis. There is, however, a high risk of retinal detachment, which can be successfully treated with vitreoretinal surgery.

Management of recurrent oral herpes simplex infections

The literature has been reviewed for evidence of the efficacy of antiviral agents in both the prophylaxis and treatment of recurrent oral herpes simplex virus (HSV) infections and discussed by a panel of experts. Emphasis was given to randomized controlled trials. Management of herpes-associated erythema multiforme and Bell palsy were also considered. The evidence suggests that 5% acyclovir (ACV) in the cream base may reduce the duration of lesions if applied early. Recurrent herpes labialis (RHL) and recurrent intraoral HSV infections can be effectively treated with systemic ACV 400 mg 3 times a day or systemic valacyclovir 500 to 1000 mg twice a day for 3 to 5 days (longer in the immunocompromised). RHL in the immunocompetent can be effectively prevented with (1) sunscreen alone (SPF 15 or above), (2) systemic ACV 400 mg 2 to 3 times a day, or (3) systemic valacyclovir 500 to 2000 mg twice a day. Valacyclovir 500 mg twice a day is also effective in suppressing erythema multiforme triggered by HSV. Further studies are needed to compare treatment efficacy between topical penciclovir, docosanol, and ACV cream for RHL.

A Case of Hypertensive Keratouveitis with Endotheliitis Associated with Cytomegalovirus

Aim: While cytomegalovirus is well known as a pathogenic organism of retinitis, especially associated with human immunodeficiency virus infection, there are few reports of anterior uveitis associated with cytomegalovirus. Methods: The authors present a case of keratouveitis associated with cytomegalovirus. Results: A 70-year-old Japanese man was referred to the authors because of poorly controlled hypertensive keratouveitis in the left eye. The patient had a history of recurrent hypertensive anterior uveitis. At presentation, the corneal stroma was edematous, with Descemet's folds and pigmented keratic precipitates. The anterior chamber angle was depigmented compared to the fellow eye. Even though pupil dilation and posterior synechiae were absent, iris atrophy was not evident. His right eye appeared normal except for moderate cataract. Funduscopy of the left eye was hazy, with the optic disc showing a normal color but poorly defined details, and no apparent exdative retinitis. The best-corrected decimal visual acuity of the right and left eyes was 0.4 and 0.02, respectively. Intraocular pressure was 11 mmHg in the right eye and 35 mmHg in the left, despite maximum medical therapy. Systemic acyclovir and prednisolone for a month did not improve the hypertensive keratouveitis. The aqueous humor was investigated for herpes simplex virus, varicella-zoster virus and cytomegalovirus. Cytomegalovius genome was detected by polymerase chain reaction analysis. Oral valganciclovir rapidly reduced ocular hypertension within a week. CMV DNA disappeared 3 months after the initiation of valganciclovir. Conclusion: The authors reported a case of hypertensive keratouveitis with endotheliitis associated with cytomegalovirus.

Acute Retinal Necrosis: Features, Management, and Outcomes

To determine the viral diagnosis and factors affecting the visual outcome of eyes with acute retinal necrosis. Nonrandomized, retrospective, interventional, noncomparative series. A cohort of 22 human immunodeficiency virus-negative patients with acute retinal necrosis (ARN). There were 17 unilateral and 5 bilateral cases. Diagnostic vitreous biopsy for polymerase chain reaction (PCR) viral DNA analysis, prophylactic barrier laser posterior to necrotic retina to try to prevent rhegmatogenous retinal detachment (RD), intravenous acyclovir in combination with oral, and vitrectomy for RD repair. Results of PCR viral DNA analysis, relationship between prophylactic barrier argon laser photocoagulation and occurrence of RD, and visual acuities at presentation and follow-up. Varicella-zoster virus (VZV) was detected in 66.7% (12/18) of eyes (66.7% of patients [10/15]) with vitreous biopsy and herpes simplex virus (HSV) in 22.2% (4/18) of eyes (20% of patients [3/15]). Epstein-Barr virus (EBV) was detected in 16.7% (3/18) of eyes (20% of patients [3/15]), and all the EBV-positive eyes were also positive for VZV. Polymerase chain reaction results were identical in both eyes of bilateral cases (5 patients) and were negative in 11.1% (2/18) of eyes (13.3% of patients [2/15]) biopsied. Systemic corticosteroid treatment given before ARN diagnosis did not appear to increase the risk of developing RD (P = 0.69). Rhegmatogenous RD occurred in 35.3% (6/17) of eyes given prophylactic argon laser treatment and in 80% (8/10) of eyes that could not be lasered prohylactically. Of RDs, 96.3% (13/14) occurred after the third week and up to 5 months from onset of symptoms. The VA after surgical repair of RD improved relative to the presentation acuity in 33.3% (4/12) of eyes. Varicella-zoster virus is the leading cause of ARN. We recommend the management of ARN to include prompt diagnosis; prophylactic argon laser retinopexy, preferably within the first 2 weeks to reduce risk of RD; systemic acyclovir; and corticosteroids to control the severe inflammation associated with ARN. Despite the guarded visual prognosis, RD repair may result in improved visual outcomes.

Eczema herpeticum: Pathogenesis and therapy

Eczema herpeticum is an acute, disseminated herpes simplex virus infection which remains a feared complication of eczematous skin diseases, especially atopic dermatitis. The vesicular and erosive clinical picture is often accompanied by systemic signs and symptoms. Why some atopic patients experience multiple attacks of eczema herpeticum and others never have the disorder remains a mystery. Patients with severe or untreated atopic dermatitis are more likely to be affected. The pathogenesis appears to involve a complex interplay of factors, including demasking of binding sites for the virus through the dermatitis, failure to up-regulate antiviral proteins and a lack of plasmacytoid dendritic cells. Treatment of choice is systemic acyclovir therapy.

Risk factors for oral hairy leukoplakia in HIV‐infected adults of Brazil

Oral hairy leukoplakia (OHL) may be an indicator of the progression of Human Immunodeficiency Virus (HIV)-induced immuno-depression, and the evaluation of risk factors leading to OHL is important in the management of these HIV-infected patients. However, there are few studies that analyze risk factors leading to OHL in the Brazilian population. The aim of this case-control study is to present data about prevalence rates and risk factors leading to OHL in a sample of HIV-infected adults in Brazil. This case-control study included 111 HIV-infected patients treated at a clinic for sexually transmitted diseases and HIV. In the initial examinations with dentists, variables were collected from all patients. Diagnosis of OHL was performed in accordance with the International Classification System and cytological features. The Fisher and the chi-squared tests were used for statistical analysis. The proportional prevalence and odds ratio were estimated. Outcome presented a positive, statistically significant association among the presence of OHL and viral load of 3000 copies/mul or greater (P = 0.0001; odds ratio (OR) = 5.8), presence of oral candidiasis (P = 0.0000; OR = 11.1), previous use of fluconazole (P = 0.0000; OR = 24.6), and use of systemic acyclovir (P = 0.032; OR = 4.3). Antiretroviral medication presented a negative, statistically significant association with the presence of OHL (P = 0.002; OR = 8.4). Prevalence of OHL was 28.8%. Viral load, oral candidiasis, previous use of fluconazole, and systemic acyclovir were determined to be risk factors for OHL. Antiretroviral medication proved to be protective against the development of OHL.