title: Oropharyngeal yeast colonization in HIV-infected outpatients in southern Taiwan: CD4 count, efavirenz therapy and intravenous drug use matter.
abstract: To understand the status of oropharyngeal yeast colonization in human immunodeficiency virus (HIV) -infected outpatients in the era of highly active antiretroviral therapy (HAART), we conducted a prospective, cross-sectional study from October 2009 to January 2010 at a medical centre in southern Taiwan. Fungal cultures of the oropharyngeal swabs were performed on 327 enrolled patients. At enrolment, 258 (79%) patients had been receiving HAART, and 42 (12.8%), 73 (22.3%) and 212 (64.8%) patients had CD4 cell counts ≤200, 201-350, and >350 cells/mm(3) , respectively. Oral yeast colonization was detected in 193 (59%) patients, among whom 157 (81.3%), 25 (13.0%), and 11 (5.7%) were colonized by a single, two and more than two species, respectively. Multivariate analysis showed that receipt of efavirenz-containing regiments and CD4 cell counts >200 cells/mm(3) were associated with lower risks of oral yeast colonization, while intravenous drug users were at a higher risk. Among the 241 isolates recovered, Candida albicans accounted for 69.7%, followed by C. dubliniensis (9.5%), C. glabrata (8.3%), C. tropicalis (3.3%), C. intermedia (2.1%), C. parapsilosis (1.7%), and 11 other species (5.4%). Overall, 230 (95.4%), 236 (97.9%) and 240 (99.6%) isolates were susceptible to fluconazole, voriconazole and amphotericin B, respectively. In conclusion, colonization by C. dubliniensis has emerged in recent years. In addition to a CD4 cell count ≤200 cells/mm(3) , which is a known risk factor for oropharyngeal yeast colonization in HIV-infected patients that was identified in our previous studies, two risk factors, non-receipt of efavirenz-based combinations and intravenous drug use, were first identified in the present study. Fluconazole remained effective in vitro against the yeasts colonizing the oropharynx in this population.
authors.affiliation: National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, Taiwan.
authors.forename: C-J
authors.initials: CJ
authors.lastname: Wu
authors.forename: H-C
authors.initials: HC
authors.lastname: Lee
authors.forename: Y-L
authors.initials: YL
authors.lastname: Yang
authors.forename: C-M
authors.initials: CM
authors.lastname: Chang
authors.forename: H-T
authors.initials: HT
authors.lastname: Chen
authors.forename: C-C
authors.initials: CC
authors.lastname: Lin
authors.forename: N-Y
authors.initials: NY
authors.lastname: Lee
authors.forename: W-L
authors.initials: WL
authors.lastname: Chu
authors.forename: L-Y
authors.initials: LY
authors.lastname: Hsieh
authors.forename: Y-L
authors.initials: YL
authors.lastname: Wang
authors.forename: T-L
authors.initials: TL
authors.lastname: Lauderale
authors.forename: F-C
authors.initials: FC
authors.lastname: Tseng
authors.forename: N-Y
authors.initials: NY
authors.lastname: Ko
authors.forename: W-C
authors.initials: WC
authors.lastname: Ko
authors.forename: H-J
authors.initials: HJ
authors.lastname: Lo
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology; D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D048588:Benzoxazines / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D002180:Candidiasis, Oral / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D003430:Cross-Sectional Studies; D003521:Cyclopropanes; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000382:microbiology*; D010045:Outpatients / Q000706:statistics & numerical data; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013624:Taiwan; D055815:Young Adult
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D000935:Antifungal Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D018894:Reverse Transcriptase Inhibitors; D015725:Fluconazole; C098320:efavirenz