Association between oral candidiasis and low CD4+ count among HIV positive patients in Hoima Regional Referral Hospital

Abstract

BackgroundThe aim of this study was to determine the prevalence of Human Immune Virus (HIV) related oral lesions and their association with Cluster of Differentiation 4 (CD4+) count among treatment naïve HIV positive patients.MethodsThis was a descriptive and analytical cross sectional study. Participants were 346 treatment naïve HIV positive adult patients. These were consecutively recruited from Hoima Regional Referral hospital between March and April 2012. Data collection involved interviews, oral examinations and laboratory analysis.ResultsA total of 168(48.6%) participants had oral lesions. The four commonest lesions were oral candidiasis (24.9%, CI = 20.6-29.7%), melanotic hyperpigmentation (17.3%, CI = 13.7-21.7%), kaposi sarcoma (9.3%, CI = 6.6-12.8%) and Oral Hairy Leukoplakia (OHL) (5.5%, CI = 3.5-8.4%). There was significant association between oral candidiasis and immunosuppression measured as CD4+ less than 350 cells/mm3 (OR = 2.69, CI = 1.608-4.502, p < 0.001). Oral candidiasis was the only oral lesion significantly predictive of immunosuppression (OR = 2.56, CI = 1.52-4.30, p < 0.001) with a Positive Predictive Value (PPV) of 48.2%, Negative Predictive Value (NPV) of 74.3%, 38.1% sensitivity and specificity of 81.4%.ConclusionOral candidiasis can be considered as a marker for immunesuppression, making routine oral examinations essential in the management of HIV positive patients.

<p>Factors Associated with Oral Candidiasis in People Living with HIV/AIDS: A Case Control Study</p>

“…24 Nanteza et al, in 2014, with their descriptive and analytical cross-sectional study in Uganda also showed there was a significant association between oral candidiasis and CD4 counts less than 350 cells/ μL (P<0.001; OR=2.69; 95% CI: 1.608-4.502). 37 A study in Brazil also concluded CD4 less than 350 cell/μL had a higher risk for developing OC compared more than 500 (p<0.001; OR=3.82; 95% CI: 2.16-6.77). 30 Takahashi et al, in 2015, reported the significant association between CD4 cell counts less than 100/µL with Candidiasis (p< 0.001).…”

“…41 Nanteza et al, in 2014, showed clinical WHO stage 3 had three times higher to develop OC compared to stage 1 (p=0.025; OR=3.803; 95% CI: 1.182-12.240). 37 Putranti et al, in 2018, also showed oral candidiasis mostly appeared in clinical stage 4. A study held in India revealed an oral lesion was considered to be marker of progression of HIV into the final clinical stage of AIDS.…”

In Vitro and In Vivo Antifungal Activity of Lichochalcone-A against Candida albicans Biofilms

“…albicans lives commensally in the gut, oral pharyngeal, genito-urinary tract and skin [ 2 ]. However, pathogenicity and subsequent candidiasis can occur under immunocompromised conditions [ 3 , 4 ]. For instance, the incidence of at least one episode of oral candidiasis in HIV patients is estimated to be 80–95% [ 5 ].…”

The estimated burden of fungal disease in South Africa

“…National + international Kreusch and Karstaedt, 2013 [39] Tshukutsoane and Scribante, 2008 [40] Govender et al, 2016 [37] Candida peritonitis Post-surgical Candida peritonitis is half as common as ICU-related candidemia; PD patients assumed to have 1.7 episodes of peritonitis per year, with 3.8% due to Candida National + international Montravers et al, 2011 [41] Okpechi et al, 2012 [42] Isla et al, 2014 [43] Oral candidiasis Among adults, 38% of PLWH with CD4+ <350 cells/µL; for children living with HIV, oral candidiasis assumed to affect 37% not on ART and 5% on ART National + regional Arendorf et al, 1998 [44] Nanteza et al, 2014 [45] Meless et al, 2014 [46] Rwenyonyi et al, 2011 [48] Oesophageal candidiasis 20% of PLWH with CD4 <200 cells/µL International Smith and Orholm, 1990 [49]…”

“…[42,43] Oral candidiasis was assumed to affect 38% of adult PLWH who had CD4+ counts <350 cells/µL; this estimate was based on a large SA study in the pre-ART era that reported oral candidiasis among 38% of HIV-infected patients, [44] in addition to a study from Uganda that suggested that this opportunistic infection is significantly more likely below this CD4+ threshold. [45] Oral candidiasis was assumed to affect 5% of children living with HIV on ART [46] and 37% of children living with HIV not taking ART, [47,48] based on data from elsewhere in sub-Saharan Africa. Oesophageal candidiasis was assumed to affect 20% of adult PLWH who had CD4+ counts <200 cells/µL, based on a study from Denmark of patients with AIDS; [49] estimates were not attempted for this disease among children.…”