Epstein-Barr Virus-Related Oral T-cell Lymphoma Associated With Human Immunodeficiency Virus Immunosuppression

PSTEIN-BARR VIRUS (EBV) is a human herpes virus E that infects B cells and certain squamous epithelia. Both cell types are thought to contribute to the long-term camage of EBV in vivo. Full replication with virus produc- tion takes place in oropharyngeal epithelium followed by a latentlnonproductive virus infection in circulating B cells.' In immunocompetent individuals, this persistent cellular infection by EBV is under strict immunologic control and rarely causes severe disease in normal seropositive individ- uals. In circumstances of severe immune suppression, it is now well recognized that EBV is closely associated with a range of diseases that histogenically reflect the host cell tar- gets of infection. These diseases include rapidly progressive B-lymphoproliferative disorders associated with congenital immunodeficiency or with iatrogenically induced immuno- suppression in bone marrow and organ transplant recipi- ents,2 undifferentiated B-cell lymphoma in patients with ac- quired immunodeficiency syndrome (AIDS) in which 40% to 77% oftumors are associated with EBV,3,4 and the benign AIDS-related oral lesion, hairy leukoplakia (HL),5 which is a unique clinical manifestation of productive EBV infection in squamous The restricted target-cell specificity for EBV has lately been challenged by evidence that normal T cells can support stable EBV infection in vitro,' and by reports of EBV DNA and/or viral gene products in various T-cell disorders rang-