title: Determinants of symptomatic vulvovaginal candidiasis among human immunodeficiency virus type 1 infected women in rural KwaZulu-Natal, South Africa.
abstract: BACKGROUND
  We sought to determine the association between HIV-induced immunosuppression, virologic correlates, and vulvovaginal candidiasis (VVC).
  
  
  METHODS
  This is a retrospective cohort study, where HIV infected and uninfected women were studied with VVC being the primary outcome. Ninety-seven HIV-infected and 101 HIV-uninfected women were enrolled between June and December 2011. Cases of VVC were confirmed. HIV RNA load was determined by RT-PCR and CD4 counts were obtained from medical records.
  
  
  RESULTS
  Fifty-two of 97 (53.6%) HIV-infected and 38/101 (37.6%) HIV-uninfected women were diagnosed with VVC (P = 0.032). The relative risk for VVC amongst HIV-infected patients was 1.53 (95% CI: 1.04-2 P = 0.024). Cases of VVC increased at CD4+ T cell count below 200 cells/mm(3) (P < 0.0001) and plasma HIV RNA load above 10 000 copies/mL (P < 0.0001). VVC was associated with increased genital shedding of HIV (P = 0.002), and there was a linear correlation between plasma HIV load and genital HIV shedding (r = 0.540; R (2) = 0.292; P < 0.0001). Women on HAART were 4-fold less likely (P = 0.029) to develop VVC.
  
  
  CONCLUSIONS
  CD4 counts below 200 cells/mm(3) and plasma HIV loads ≥10 000 copies/mL were significantly associated with VVC.
authors.affiliation: Department of Infection Prevention and Control and Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Private Bag 7, Congella, Durban 4013, South Africa ; Department of Medical Microbiology, Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha, Eastern Cape 5117, South Africa.
authors.forename: Teke
authors.identifier: 0000-0002-1329-3864
authors.initials: T
authors.lastname: Apalata
authors.affiliation: HIV Pathogenesis Programme (HPP), Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban 4013, South Africa ; Department of Biology, Medgar Evers College, City University of New York, Brooklyn, NY 11225, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Carr
authors.affiliation: Department of Infection Prevention and Control and Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Private Bag 7, Congella, Durban 4013, South Africa.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Sturm
authors.affiliation: Department of Medical Microbiology, Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha, Eastern Cape 5117, South Africa.
authors.forename: Benjamin
authors.identifier: 0000-0002-5164-6296
authors.initials: B
authors.lastname: Longo-Mbenza
authors.affiliation: Department of Infection Prevention and Control and Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Private Bag 7, Congella, Durban 4013, South Africa.
authors.forename: Prashini
authors.initials: P
authors.lastname: Moodley
mesh_terms: D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D002181:Candidiasis, Vulvovaginal / Q000453:epidemiology / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000382:microbiology* / Q000821:virology; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult