When CD4+ levels drop below 500 cells/microL, patients are at risk for Candida albicans overgrowth. This fungal infection leads to oral thrush, forming white plaques on the mouth and tongue, which can be scraped off, leaving erythematous and bloody lesions.
Kaposi's sarcoma develops secondary to infection by human herpesvirus-8 or HHV-8. Patients develop papular nodules and blotches that are purple, blue, black, and red. These are typically seen on the skin but can also affect the GI and respiratory systems.
Patients with this level of immunodeficiency are also at increased risk of expressing more manifestations of human papillomavirus infection, or HPV. These include the presence of warts and, more severely, squamous cell carcinoma. In males who have sex with other males, this can be carcinoma of the anus, though it can also occur in the cervix in women.
Epstein-Barr Virus, or EBV, can manifest as oral hairy leukoplakia in HIV-infected patients who have a CD4+ count below 500 cells/microL. This manifestation is different from oral thrush associated with candida albicans because, with oral hairy leukoplakia, the white plaques are unscrapable. These typically present on the lateral tongue with a hairy, corrugated appearance.
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