Effect of prolonged HAART on oral colonization with Candida and candidiasis.
BACKGROUND
Progressive cell-mediated immunodeficiency with decrease of CD4+ lymphocyte count to less than or equal to 200 cells/mm3 is a major risk factor for colonization with Candida species and development of candidiasis. Oropharyngeal candidiasis may occur in up to 90% of human immunodeficiency virus (HIV)-infected patients during the course of the disease. This study is to determine the effect of prolonged highly active antiretroviral therapy (HAART) on oropharyngeal colonization with Candida species and oral candidiasis.


METHODS
A prospective, longitudinal follow-up study in HIV-infected patients receiving HAART.


RESULTS
The mean CD4+ count increased from 232.5 to 316 cells/mm3 and the proportion of patients whose CD4+ count less than 200 cells/mm3 decreased from 50.0% to 28.9% (p = 0.0003) in patients receiving HAART for at least 2 years. The prevalence of oral candidiasis decreased from 10.6% to 2.1% (p = 0.004). The decrease in Candida colonization was less impressive, falling from 57.8% to 46.5 % (p = 0.06). Of the 142 patients enrolled in at least two surveys, 48 (33.8%) remained colonized with Candida and 42 (29.6%) remained negative. In the remaining 52 patients, 34 switched from culture positive to negative, and an increase in CD4+ lymphocytes was noted in 91.2% of them. Among the 18 patients who switched from culture negative to positive, 61.1% also demonstrated an increase in CD4+ lymphocyte count (p = 0.01).


CONCLUSIONS
These findings indicate that HAART is highly effective in decreasing oral candidiasis in association with a rise in CD4+ lymphocyte counts, but only marginally effective in eliminating Candida from the oropharynx.
Yang
Yun-Liang
YL
Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, ROC. yyang@mail.nctu.edu.tw
Lo
Hsiu-Jung
HJ
Hung
Chien-Ching
CC
Li
Yichun
Y
D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002175:Candida / Q000187:drug effects* / Q000302:isolation & purification / Q000502:physiology; D002180:Candidiasis, Oral / Q000150:complications* / Q000188:drug therapy; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009960:Oropharynx / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents; D000935:Antifungal Agents