title: Candidiasis and other oral mucosal lesions during and after interferon therapy for HCV-related chronic liver diseases.
abstract: BACKGROUND
  Oral lichen planus (OLP) is seen frequently in patients with hepatitis C virus (HCV) infection. The aim of this study was to evaluate the occurrence of oral candidiasis, other mucosal lesions, and xerostomia during interferon (IFN) therapy for HCV infection.
  
  
  METHODS
  Of 124 patients with HCV-infected liver diseases treated with IFN therapy in our hospital, 14 (mean age 56.00 ± 12.94 years) who attended to receive administration of IFN once a week were identified and examined for Candida infection and other oral lesions and for the measurement of salivary flow. Serological assays also were carried out.
  
  
  RESULTS
  Cultures of Candida from the tongue surfaces were positive in 7 (50.0%) of the 14 patients with HCV infection at least once during IFN therapy. C. albicans was the most common species isolated. The incidence of Candida during treatment with IFN did not increase above that before treatment. Additional oral mucosal lesions were observed in 50.0% (7/14) of patients: OLP in three (21.4%), angular cheilitis in three (21.4%) and recurrent aphthous stomatitis in one (7.1%). OLP occurred in one patient before treatment with IFN, in one during treatment and in one at the end of treatment. 85.7% of the oral lesions were treated with topical steroids. We compared the characteristics of the 7 patients in whom Candida was detected at least once during IFN therapy (group 1) and the 7 patients in whom Candida was not detected during IFN therapy (group 2). The prevalence of oral mucosal lesions (P=0.0075) and incidence of external use of steroids (P=0.0308) in group 1 were significantly higher than in group 2. The average body weight of group 1 decreased significantly compared to group 2 (P=0.0088). Salivary flow decreased in all subjects throughout the course of IFN treatment and returned at 6th months after the end of treatment. In group 1, the level of albumin at the beginning of the 6th month of IFN administration was lower than in group 2 (P=0.0550). According to multivariate analysis, one factor, the presence of oral mucosal lesions, was associated with the detection of Candida. The adjusted odds ratio for the factor was 36.00 (95% confidence interval 2.68-1485.94).
  
  
  CONCLUSIONS
  We should pay more attention to oral candidiasis as well as other oral mucosal lesions, in patients with weight loss during IFN treatment.
authors.affiliation: Department of Digestive Disease Information & Research, Kurume University School of Medicine, Kurume, Fukuoka, Japan. nagao@med.kurume-u.ac.jp
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Nagao
authors.forename: Kouji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Michio
authors.initials: M
authors.lastname: Sata
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002180:Candidiasis, Oral / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000821:virology; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use; D017676:Lichen Planus, Oral / Q000139:chemically induced / Q000453:epidemiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000009:adverse effects* / Q000627:therapeutic use; D015995:Prevalence; D012254:Ribavirin / Q000627:therapeutic use; D012469:Salivary Glands / Q000187:drug effects / Q000378:metabolism / Q000821:virology; D012709:Serum Albumin / Q000032:analysis; D013256:Steroids / Q000627:therapeutic use; D013280:Stomatitis / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D016896:Treatment Outcome; D015431:Weight Loss / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; C571406:PEG-IFN-SA; D012709:Serum Albumin; D013256:Steroids; D011092:Polyethylene Glycols; D012254:Ribavirin