title: Salivary secretory leukocyte protease inhibitor and oral candidiasis in human immunodeficiency virus type 1-infected persons.
abstract: Oropharyngeal candidiasis, typically caused by Candida albicans, is the most common oral disease associated with human immunodeficiency virus type 1 (HIV-1) infection. Secretory leukocyte protease inhibitor (SLPI), a 12-kDa antiprotease, suppresses the growth of C. albicans in vitro. To determine whether the mucosal protein plays a role in protecting oral tissues against fungal infection, we conducted a cross-sectional study investigating the oral and systemic health and salivary SLPI levels in 91 dentate HIV-1-infected adults receiving medical care in the southeastern United States. Participants with a self-reported history of clinical oropharyngeal candidiasis during the previous 2 years constituted the test group (n = 52), while the comparison group (n = 39) had no oropharyngeal candidiasis during that period. Data collected from medical records, oral examination, and SLPI enzyme-linked immunosorbent assay quantitation of whole saliva were analyzed by t test, analysis of variance, linear regression, and unconditional logistic regression. The test group had a significantly higher mean salivary SLPI level than the comparison group (1.9 microg/ml versus 1.1 microg/ml, P < 0.05). Linear regression modeling identified CD4 cell count and history of oropharyngeal candidiasis as key predictors of salivary SLPI and revealed a significant interaction (P < 0.05) between immunosuppression (CD4 cell count below 200 cells/ microl) and positive history of oropharyngeal candidiasis in predicting salivary SLPI level. By logistic regression modeling, a salivary SLPI level exceeding 2.1 microg/ml, low CD4 count, antiretroviral monotherapy, and smoking were key predictors of oropharyngeal candidiasis. These data support a key role for SLPI in the oral mucosal defense against C. albicans. The antimicrobial mucosal protein may serve as an indicator of previous oropharyngeal candidiasis infection among immunosuppressed persons.
authors.affiliation: School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Chattopadhyay
authors.forename: Laurie R
authors.initials: LR
authors.lastname: Gray
authors.forename: Lauren L
authors.initials: LL
authors.lastname: Patton
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Caplan
authors.forename: Gary D
authors.initials: GD
authors.lastname: Slade
authors.forename: Hsaio-Chuan
authors.initials: HC
authors.lastname: Tien
authors.forename: Diane C
authors.initials: DC
authors.lastname: Shugars
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology* / Q000378:metabolism / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D002176:Candida albicans / Q000472:pathogenicity; D002180:Candidiasis, Oral / Q000276:immunology* / Q000378:metabolism / Q000382:microbiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D053491:Proteinase Inhibitory Proteins, Secretory; D011506:Proteins / Q000737:chemistry / Q000378:metabolism*; D012463:Saliva / Q000737:chemistry / Q000276:immunology* / Q000378:metabolism; D053481:Secretory Leukocyte Peptidase Inhibitor
chemical_list: D053491:Proteinase Inhibitory Proteins, Secretory; D011506:Proteins; C506814:SLPI protein, human; D053481:Secretory Leukocyte Peptidase Inhibitor