Oral candidiasis and seborrheic dermatitis in HIV‐infected patients on highly active antiretroviral therapy

Abstract

BackgroundMucocutaneous manifestations such as oral candidiasis (OC) and seborrheic dermatitis (SD) are very common HIV-related opportunistic events and are usually initial markers of immunodeficiency. AimThe purpose of this study was to evaluate the efficacy of highly active antiretroviral therapy (HAART) in the regression of HIV-associated OC and SD. MethodsIn a prospective study, 120 HIV-infected patients with OC and SD were divided into two groups: HAART-treated patients (group 1, n 5 76) and non-HAART-treated patients (group 2, n 5 44). Non-HAART-treated patients were given antimicrobial therapy. Study subjects were matched for sex, age, risk, and stage of HIV infection. The results were analysed by w 2 test and the Kaplan-Meier method. ResultsAt baseline, OC was evident in 59 (77.7%) of the HAART-treated patients and in 34 (77.3%) of the non-HAART-treated patients, while SD was present in 19 (25.0%) of the HAART-treated patients and in 17 (38.6%) of the non-HAART-treated patients. After a median follow-up period of 22 months, regression of OC and SD occurred in 49 (83.1%) and 16 (84.2%) of the HAART-treated patients, respectively. In the control group, regression of OC and SD occurred in only five (14.7%) and seven (41.2%) patients, respectively, during the same period. ConclusionsHAART showed greater efficacy than standard antimicrobial therapy for the treatment of OC and SD in HIV-infected patients. Oral candidiasis is the most common oral feature of opportunistic fungal infection, occurring in 90% patients during the course of HIV disease, and is an important criterion in most clinical staging systems for HIV infection [4,7]. SD is a common skin condition among HIV-infected persons, with a prevalence of 7-50%, and is also closely related to the stage of HIV infection [6,8].The introduction of highly active antiretroviral therapy (HAART) has resulted in a dramatic decline in the incidence of opportunistic infections. HAART has led to reductions in disease progression and mortality [5,[9][10][11][12][13].The aim of the study was to evaluate the efficacy of HAART regarding the regression of HIV-associated OC and SD. A total of 120 HIV-infected patients (53 women and 67 men; ages ranging from 9 to 67 years) with mucocutaneous manifestations were divided into two groups: 76 patients treated with HAART (59 OC and 19 SD) and 44 non-HAART-treated patients (34 OC and 17 SD; control group) treated with antimicrobial therapy.Diagnoses of OC and SD were based on clinical manifestations (Figs 1 and 2) and confirmed using smears taken from lesions and examined by potassium hydroxide preparation for Candida albicans, plus fungal cultures to identify the causitive organism, and for Pityrosporum ovale, at the beginning of the study and during the follow-up period.The HAART regimen consisted of one protease inhibitor (saquinavir, nelfinavir, ritonavir or indinavir) and two reverse transcriptase inhibitors (zidovudine, didanosine, stavudine, lamivudine or abacavir). The HAART-treated patients did not receive standard derm...

Dermatite seborreica

“…108 Response to antiretroviral treatment is variable and there have been conflicting reports in the literature: some investigators reported an improvement in SD with the initiation of antiretroviral treatment, while others reported aggravation. 109,110 Furthermore, there have been reports of aggravation during immune reconstitution inflammatory syndrome and reports that antiretroviral treatment does not alter the prevalence or the course of SD. 111,112 With respect to histopathology, the findings of SD in HIV-positive patients are similar to those found in HIV-negative patients; however, there appears to be greater follicular involvement in the lesions and more plasmocytes in the inflammatory infiltrate in the HIVpositive patients.…”

“…114 There have also been reports of a clinical improvement with the use of antiretroviral drugs. 109,115 …”

Efficacy of Pulse Therapy of Oral Fluconazole in the Treatment of Seborrheic Dermatitis

“…The skin commensal yeasts Malassezia is known to cause the disease. Correlation of severity of the disease with the number of yeasts and decrease in the number of Malassezia after treatment seem to support that this may be caused by Malassezia yeast 4 . Although there is no definitive care, topical corticosteroids, tar, sulfur, pyrithione sulfide, ciclopiroxolamine, terbinafine, butenafine, azoles such an ketoconazole, bifonazole, itraconazole, metronidazole, fluconazole; tacrolmus, pimecrolimus, lithium succinate and cinnamic acid may be used.…”

“…For this reason and also for better gastrointestinal tolerance, fluconazole has the widest therapeutic index of the azole, permitting more aggressive dosing in a variety of fungal infections 6 . Since seborrheic dermatitis is a relapsing condition, use of topical agents may not be suitable on a long-term basis and oral treatment is preferred by patients who are refractory to topical treatment, relapse frequently, or have disease that affects large areas 4 .…”

Isolation, Speciation and Characterization of Candida Species in Clinical Isolates

“…Candida albicans was the most common species isolated from oral lesions/swabs of HIV positive patients accounting for 50% (2) of total 4 oral swabs. In previous studies done by Dunic et al, (2004), Mrudula Patel et al, (2006), Omar et al, (2008) C. albicans was the most common species isolated in oral swabs of HIV positive patients in the percentage of 77.7%, 83.5%, 78.6% and 84.5% respectively. Percentage of NAC spp.…”