Colonization of Human Immunodeficiency Virus-Infected Outpatients in Taiwan with Candida Species

Abstract

To understand the Candida colonization of human immunodeficiency virus (HIV)-infected outpatients inTaiwan, we have conducted a prospective cohort study of Candida colonization and its risk factors at the National Taiwan University Hospital from 1999 to 2002. More than 50% of the patients were colonized with Candida species, and 12% developed symptomatic candidiasis. Patients colonized with fluconazole-resistant strains of Candida species had a higher prevalence of candidiasis than those colonized with susceptible strains. Our analysis found that antibiotic treatment and lower CD4؉ counts (<200 cells/mm 3 ) increased the rate of oropharyngeal candidiasis in HIV-infected patients, while antiretroviral therapy protected patients from the development of candidiasis.Mucosal candidiasis, including oropharyngeal, esophageal, and vaginal candidiasis, is common among human immunodeficiency virus (HIV)-infected patients (4, 11). In particular, oropharyngeal candidiasis occurs in up to 90% of patients during the course of HIV infection (17). Progressive cellmediated immunodeficiency, with CD4 ϩ lymphocyte counts less than 200 cells/mm 3 , is a risk factor for colonization with Candida species and the development of candidiasis (3). The widespread use of azole antifungal agents for the treatment of mucosal candidiasis results in colonization with less susceptible organisms and the development of resistance (4, 15). Thus, oropharyngeal candidiasis due to drug-resistant fungi is an emerging problem for patients infected with HIV (18).The overall prevalence of known HIV infection in Taiwan remains relatively low (0.01%) (9). As in most other industrialized countries, the majority of HIV-infected patients in Taiwan receive care in the outpatient setting. Therefore, to better understand the epidemiology of Candida species carriage among HIV-infected outpatients in Taiwan, we undertook a study to determine the prevalence of oropharyngeal colonization. Our objectives were to assess the colonization status and the risk factors for colonization and the development of candidiasis in HIV-infected outpatients in Taiwan. The susceptibilities of those Candida isolates to antifungal drugs were also determined. MATERIALS AND METHODSStudy population and data collection. HIV-infected patients were monitored regularly in the outpatient infectious diseases clinic of National Taiwan University Hospital, a major referral hospital for the management of HIV-related complications. The patients were enrolled after they provided informed verbal consent. This was a prospective study performed by the use of three surveys, conducted from May to June 1999, May to September 2001, and January to April 2002. A standardized data collection form was used to retrieve demographic information, the most recent CD4 ϩ lymphocyte count, and the highly active antiretroviral therapy (HAART) prescribed. In addition, clinical information for the previous 3 months was obtained and included information on whether the patient had a history of oral or esophageal candidiasi...

Oropharyngeal Colonization of HIV-Infected Outpatients in Taiwan by Yeast Pathogens

“…The patient characteristics are summarized in Table 1. HIV-infected patients with progressive immunodeficiency (CD4 ϩ counts Յ 200 cells/mm 3 ) appear to have higher prevalence of yeast colonization (P ϭ 0.17), a result supporting our previous finding showing that low CD4 ϩ count is a risk factor (10,23). Furthermore, we found that high HIV viral load (P ϭ 0.003) increased the rate of yeast colonization, whereas receipt of HAART (P ϭ 0.044) protected these patients from yeast colonization.…”

“…In addition, receipt of antibacterial therapy was highly associated with yeast oropharyngeal colonization (P ϭ 0.002). This is consistent with other studies (10,14). Based on multivariate analysis, antibacterial therapy was the only independent risk factor for oropharyngeal yeast colonization (odds ratio, 2.7; 95% confidence interval, 1.27 to 5.84).…”

“…Oropharyngeal colonization with yeasts is known to be significantly higher among HIV-infected patients than among healthy individuals, and the rate of colonization varied from 44% to 88% (1,6,14,18). More than half of the HIV-infected patients (53.4%) enrolled in this study were colonized by yeast pathogens, a rate similar to that in our previous report (10). The patient characteristics are summarized in Table 1.…”

Assessment of Candida glabrata Strain Relatedness by Pulsed-Field Gel Electrophoresis and Multilocus Sequence Typing

“…The isolates that were superficial colonizers were collected from anal swabs (30 isolates), stool specimens (2 isolates), sputum specimens (9 isolates), throat swab specimens (3 isolates), and urine specimens (9 isolates); fewer invasive isolates were collected and were obtained from ascites (1 isolate), the tip of a central venous catheter (CVC; 1 isolate), and drainage fluid (1 isolate). Twentyfour isolates were cultured from oral swab or sputum specimens from 10 HIVinfected patients during 2001 and 2002 (25). The information on each isolate is listed in Table 1.…”

Increased expression of virulence attributes in oral Candida albicans isolates from human immunodeficiency virus-positive individuals

“…Up to 90 % of HIV-positive individuals suffer from mucosal candidiasis at least once in the course of their disease (Hung et al, 2005); this typically involves the oral cavity, with an occasional spread to the oesophagus. The overall severity and chronicity of oral candidiasis has been attributed exclusively to the HIV-induced immune deficiency of the affected individuals and not to the virulence factors of the pathogen (Ollert et al, 1995).…”