title: Role of oral candidiasis in TB and HIV co-infection: AIDS Clinical Trial Group Protocol A5253.
abstract: OBJECTIVE
  To evaluate the association between oral candidiasis and tuberculosis (TB) in human immunodeficiency virus (HIV) infected individuals in sub-Saharan Africa, and to investigate oral candidiasis as a potential tool for TB case finding.
  
  
  METHODS
  Protocol A5253 was a cross-sectional study designed to improve the diagnosis of pulmonary TB in HIV-infected adults in high TB prevalence countries. Participants received an oral examination to detect oral candidiasis. We estimated the association between TB disease and oral candidiasis using logistic regression, and sensitivity, specificity and predictive values.
  
  
  RESULTS
  Of 454 participants with TB culture results enrolled in African sites, the median age was 33 years, 71% were female and the median CD4 count was 257 cells/mm(3). Fifty-four (12%) had TB disease; the prevalence of oral candidiasis was significantly higher among TB cases (35%) than among non-TB cases (16%, P < 0.001). The odds of having TB was 2.4 times higher among those with oral candidiasis when controlling for CD4 count and antifungals (95%CI 1.2-4.7, P = 0.01). The sensitivity of oral candidiasis as a predictor of TB was 35% (95%CI 22-48) and the specificity 85% (95%CI 81-88).
  
  
  CONCLUSIONS
  We found a strong association between oral candidiasis and TB disease, independent of CD4 count, suggesting that in resource-limited settings, oral candidiasis may provide clinical evidence for increased risk of TB and contribute to TB case finding.
authors.affiliation: Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Shiboski
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: H
authors.initials: H
authors.lastname: Chen
authors.affiliation: Center for Medical Mycology, Department of Dermatology, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Ghannoum
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: L
authors.initials: L
authors.lastname: Komarow
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: S
authors.initials: S
authors.lastname: Evans
authors.affiliation: Center for Medical Mycology, Department of Dermatology, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Mukherjee
authors.affiliation: Center for Medical Mycology, Department of Dermatology, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: N
authors.initials: N
authors.lastname: Isham
authors.affiliation: Statistical Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: D
authors.initials: D
authors.lastname: Katzenstein
authors.affiliation: Stanford University Medical Center, Stanford, California, USA.
authors.forename: A
authors.initials: A
authors.lastname: Asmelash
authors.affiliation: Scottish Livingstone Hospital, Molepole, Botswana.
authors.forename: A E
authors.initials: AE
authors.lastname: Omozoarhe
authors.affiliation: <label>**</label>Princess Marina Hospital, Gaborone, Botswana.
authors.forename: S
authors.initials: S
authors.lastname: Gengiah
authors.affiliation: Centre for the AIDS Programme of Research in South Africa, Durban, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Allen
authors.affiliation: AIDS Clinical Trial Group Operations Center, Silver Spring, Maryland, USA.
authors.forename: S
authors.initials: S
authors.lastname: Tripathy
authors.affiliation: Molecular Virology Clinic National AIDS Research Institute, Maharashtra Industrial Development Corporation, Bhosari, India.
authors.forename: S
authors.initials: S
authors.lastname: Swindells
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000368:Aged; D018791:CD4 Lymphocyte Count; D002180:Candidiasis, Oral / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D016009:Chi-Square Distribution; D060085:Coinfection; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D055815:Young Adult