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Oral hairy leukoplakia is a common oral manifestation of HIV infection, characterized by the presence of white mucosal plaques that predominantly appear on the lateral borders of the tongue. This condition is caused by an Epstein-Barr virus (EBV) infection, which is often opportunistic in patients with immunosuppression, such as those with HIV. The appearance of the lesions is distinct; they can be described as adherent white patches that cannot be easily wiped off, which distinguishes them from other conditions.

In contrast, leukoplakia generally refers to white patches in the oral cavity that may have various causes, including irritation and potential malignant changes, and does not specifically correlate with HIV in the same way. Candidiasis, another fungal infection, presents as white patches or plaques, but these can usually be wiped off, revealing an erythematous base. Oral lichen planus is an inflammatory condition characterized by white striations or patches that can appear on the oral mucosa, but it is not primarily associated with HIV infection. Therefore, oral hairy leukoplakia is the most specific oral manifestation linked to HIV, effectively highlighting the relationship between immune status and opportunistic infections.