title: Predisposing factors for oropharyngeal colonization of yeasts in human immunodeficiency virus-infected patients: a prospective cross-sectional study.
abstract: BACKGROUND
  Oropharyngeal candidiasis continues to be a major opportunistic infection in human immunodeficiency virus (HIV)-infected patients. The objectives of this study were to investigate the prevalence, associated factors, and microbiologic features for oropharyngeal yeast colonization in HIV-infected patients.
  
  
  METHODS
  From October to December 2009, consecutive HIV-infected patients older than 18 years were recruited in this study. Demographic information, underlying conditions, and clinical histories were collected. Oropharyngeal swab cultures for yeasts and antifungal drug susceptibilities of the isolates were performed.
  
  
  RESULTS
  Of the 105 HIV-infected patients, 54 (51.4%) were colonized with yeasts, including 11 patients (20.4%) with more than one species. Among the 68 isolates, Candida albicans accounted for 73.5%, followed by Candida tropicalis (5.9%), Candida glabrata (5.9%), and Candida dubliniensis (4.4%). There were 7.5% and 6% Candida isolates resistant to fluconazole and voriconazole, respectively. All of the Candida isolates were susceptible to amphotericin B. A higher prevalence of yeast colonization was noted in patients with a CD4 cell count ≤200 cells/μL (p = 0.032). Multivariate regression analysis showed that intravenous drug use was an independent associated factor for oropharyngeal yeast colonization (odds ratio, 5.35; 95% confidence interval, 1.39-20.6; p = 0.015), as well as protease inhibitor-containing antiretroviral therapy (odds ratio, 3.59; 95% confidence interval, 1.41-9.12; p = 0.007).
  
  
  CONCLUSIONS
  Despite previous studies showing that protease inhibitors decreased Candida adhesion to epithelial cells in vitro, the current study found protease inhibitor-containing antiretroviral therapy predisposed to oropharyngeal yeast colonization in HIV-infected patients.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Jiun-Nong
authors.initials: JN
authors.lastname: Lin
authors.forename: Chih-Chao
authors.initials: CC
authors.lastname: Lin
authors.forename: Chung-Hsu
authors.initials: CH
authors.lastname: Lai
authors.forename: Yun-Liang
authors.initials: YL
authors.lastname: Yang
authors.forename: Hui-Ting
authors.initials: HT
authors.lastname: Chen
authors.forename: Hui-Ching
authors.initials: HC
authors.lastname: Weng
authors.forename: Li-Yun
authors.initials: LY
authors.lastname: Hsieh
authors.forename: Yi-Chi
authors.initials: YC
authors.lastname: Kuo
authors.forename: Tsai-Ling
authors.initials: TL
authors.lastname: Lauderdale
authors.forename: Fan-Chen
authors.initials: FC
authors.lastname: Tseng
authors.forename: Hsi-Hsun
authors.initials: HH
authors.lastname: Lin
authors.forename: Hsiu-Jung
authors.initials: HJ
authors.lastname: Lo
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000382:microbiology; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D002180:Candidiasis, Oral / Q000453:epidemiology* / Q000382:microbiology; D015984:Causality; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009960:Oropharynx / Q000382:microbiology*; D015995:Prevalence; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000935:Antifungal Agents; D017320:HIV Protease Inhibitors