title: Oral Candida colonization and its relation with predisposing factors in HIV-infected children and their uninfected siblings in Brazil: the era of highly active antiretroviral therapy.
abstract: OBJECTIVE
  To evaluate predisposing factors such as orofacial manifestations, immunosuppression status and antiretroviral therapy in relation to oral colonization by Candida spp. in Brazilian HIV-infected children and their uninfected siblings in the era of highly active antiretroviral therapy (HAART).
  
  
  METHODS
  Whole stimulated saliva was collected from 65 HIV-infected children (HIV+) and 40 uninfected siblings (HIV-), followed by assessment of orofacial manifestation, caries indexes and the number of cavitated dentinal carious teeth (CDT). The salivary samples were cultured and the colonies were counted. After which they were identified by sugar assimilation and fermentation (API 20C). Data was analyzed using chi-square, Mann-Whitney, Spearman tests and logistic regression.
  
  
  RESULTS
  Regarding positive growth, HIV+ presented 80% (52/65) and HIV- 57.5% (23/40) (P = 0.013). Absence of antiretroviral therapy and HAART increased the probability of Candida isolation (P < 0.05). Mean CD4%, immune-status and history of recurrent oral candidiasis (OC) had no influence on Candida isolation. Mixed Candida spp. cultures were observed in HIV+ (40%) and HIV- (52%): C. albicans was more frequently found in both groups, with a higher prevalence in HIV+ (P = 0.05); other non-albicans species were isolated in HIV+ and HIV-. Low prevalence of orofacial manifestations was observed in HIV+ (10.7% of OC). There was an association between means of CDT and Candida growth (P < 0.05) and a positive correlation between number of CDT and Candida cfu-counts in HIV+ and HIV-. Mean CD4% and immune-status had no influence on Candida isolation. Absence of antiretroviral therapy and HAART increased the probability of Candida isolation (P < 0.05).
  
  
  CONCLUSIONS
  The HIV infected children had a significantly higher prevalence of oral Candida spp. compared to their uninfected siblings. Absence of HAART and presence of dentinal carious teeth increased significantly Candida spp. colonization in these children.
authors.affiliation: Departamento de Odontopediatria e Ortodontia, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Brazil.
authors.forename: Daniella Ferraz
authors.initials: DF
authors.lastname: Cerqueira
authors.forename: Maristela Barbosa
authors.initials: MB
authors.lastname: Portela
authors.forename: Luciana
authors.initials: L
authors.lastname: Pomarico
authors.forename: Rosangela Maria
authors.initials: RM
authors.lastname: de Araújo Soares
authors.forename: Ivete Pomarico Ribeiro
authors.initials: IP
authors.lastname: de Souza
authors.forename: Glória Fernanda
authors.initials: GF
authors.lastname: Castro
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology*; D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D002176:Candida albicans / Q000302:isolation & purification; D041022:Candida tropicalis / Q000302:isolation & purification; D002180:Candidiasis, Oral / Q000382:microbiology*; D050260:Carbohydrate Metabolism; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015169:Colony Count, Microbial; D004245:DMF Index; D003804:Dentin / Q000473:pathology; D005260:Female; D005285:Fermentation; D015658:HIV Infections / Q000188:drug therapy*; D018023:HIV Seronegativity; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D009055:Mouth / Q000382:microbiology*; D009059:Mouth Diseases / Q000150:complications; D012008:Recurrence; D012307:Risk Factors; D012463:Saliva / Q000382:microbiology; D014094:Tooth, Deciduous / Q000473:pathology