Asymptomatic oral Candida albicans carriage in HIV‐infection: frequency and predisposing factors

Abstract

Many studies have focused on the epidemiology and pathogenesis of oral candidiasis in HIV infection. Little is known on the incidence and predisposing factors of asymptomatic oral candida carriage in this setting, obviously an important issue in view of prophylaxis. To address this question, 261 consecutive HIV-infected individuals without clinical evidence of candidiasis were investigated. C. albicans was isolated from cultured oral cavity swabs of 63 subjects (24%). Colonization was significantly more frequent in IV drug users, CDC groups IV, and in subjects with lymphocytopenia, CD4+ cell depletion, or elevated beta-2 microglobulin. These data further suggest that oral candidiasis occurs in HIV infection as a result of C. albicans overgrowth and raise the question of primary antifungal prophylaxis in subjects with low CD4 counts and asymptomatic oral Candida carriage.

Salivary Secretory Leukocyte Protease Inhibitor and Oral Candidiasis in Human Immunodeficiency Virus Type 1-Infected Persons

“…High Candida carriage has been demonstrated among HIV-1-positive persons (4,11,12), and oropharyngeal candidiasis is found in 95% of AIDS patients (27). Although our study did not determine carriage rates, we used a history of oropharyngeal candidiasis as a surrogate measure for high candidal carriage.…”

“…Due to the small number of participants with clinically detected oropharyngeal candidiasis at the study visit, the intermittent nature of oropharyngeal candidiasis (11,12), and the high prevalence of Candida carriage reported among HIV-1-positive individuals (4, 32), we used a history of oropharyngeal candidiasis as a surrogate indicator of oropharyngeal candidiasis. In support of this decision, a recent study by the Centers for Disease Control and Prevention found a selfreported history of oropharyngeal candidiasis to be a good predictor of clinical oropharyngeal candidiasis, as evaluated by repeat-measure analysis (6).…”

“…Oropharyngeal candidiasis is a sentinel indicator of immunodeficiency and HIV disease progression (20,34). The asymptomatic presence of C. albicans in the oral cavity increases the likelihood of developing clinical disease, especially following immune suppression (4,11,13). In a cross-sectional study conducted by Campisi and colleagues (4), 62% of HIV-1-positive persons harbored Candida species in their oral cavity, compared to 29% of HIV-1-negative persons.…”

Oral Candida flora from Brazilian human immunodeficiency virus-infected patients in the highly active antiretroviral therapy era

“…In particular oral candidosis occurs in more than 90% of HIV-infected patients (Korting et al 1999). Usually the main causative agent of oral candidosis in immunocompromised hosts is Candida albicans, which is a member of oral microbe flora (Odds 1984, Stenderup 1990, Fetter et al 1993. Nevertheless, in recent years several reports have described a change of oral Candida flora in HIV-infected patients (Nguyen et al 1996, Nho et al 1997).…”

Carriage Frequency, Intensity of Carriage, and Strains of Oral Yeast Species Vary in the Progression to Oral Candidiasis in Human Immunodeficiency Virus-Positive Individuals

“…Similarly, Morace et al found that 25% of the yeast species isolated from persons with AIDS were non-C. albicans species (28). Masia Canuto et al recently evaluated 153 HIV-positive patients and found that 21% of these patients had non-C. albicans species, the most common of which was Candida glabrata (23) Asymptomatic oral C. albicans carriage has been demonstrated in HIV-positive patients (5), and an increased incidence of asymptomatic oral C. albicans carriage in HIV-positive patients compared to that in other at-risk groups has also been noted (4). Thus, a higher prevalence of oral C. albicans colonization may be a predisposing factor for the subsequent development of clinical thrush.…”