Oral fungi inHIV: challenges in antifungal therapies

Abstract

Oral candidiasis (OC) caused by Candida species is a common fungal infection among HIV‐infected individuals. Despite the wide use of antiretroviral therapy (ART) resulting in a declined prevalence, OC remains the most common oral lesions seen in those living with HIV/AIDS. Various topical and systemic antifungal drugs are available to treat OC. However, due to the patients’ immunodeficiency and the nature of OC as biofilm‐associated infection, relapse is frequently observed after cessation of antifungal therapy. In addition, long‐term antifungal therapy may lead to drug resistance. This review article addressed three major challenges in the treatment of OC in HIV infection including antifungal drug resistance, biofilm‐associated infection of OC, and the host underlying immunodeficiency. To reduce the risks of antifungal drug resistance, the author recommends that future studies should focus on herbal plant‐derived compounds with antifungal activity that may be used in combination with the drugs. Also, it is recommended that more research should be carried out to explore how to enhance the host innate immunity against oral Candida.

Oral status of HIV‐infected children aged 12 years or younger who attended a Paediatric Infectious Diseases Clinic in Cape Town

“…Children living with HIV have been found to be susceptible to dental caries (Leão, Ribeiro, Carvalho, Frezzini, & Porter, 2009). Studies have established a direct relationship between caries risk and HIV, particularly with respect to the potentially cariogenic and xerostomic antiretroviral medication (Nittayananta, Chanowanna, & Winn, 2010;Nittayanata, 2016;Oliveira et al, 2015). Other factors implicated in the increased prevalence of dental caries among children with HIV include diminished flow of saliva and a reduction in salivary antibodies (dos Santos et al, 2009;Oliveira et al, 2015).…”

Amplitude-modulated cold atmospheric pressure plasma jet for treatment of oral candidiasis: In vivo study

“…Oral candidiasis is a common occurrence among HIV-positive patients [ 4 ], and it is reported as one of the first clinical manifestations of HIV infection [ 5 ]. Organ transplanted patients, elderly, diabetics and patients under corticosteroids or long-term antimicrobial therapy are also prone to develop Candida infections [ 6 – 10 ].…”

“…The discovery of molecular targets that can be used for drug development is challenging due to the similarity between fungi and human cells [ 16 ]. Combinations of conventional antifungal drugs and plant-derived compounds [ 4 ] as well as the associations among drugs [ 14 ] have been proposed as alternatives to overcome this challenge. Photodynamic inactivation has been also reported as a viable alternative for oral candidiasis [ 17 ].…”

Common oral opportunistic infections in Human Immunodeficiency Virus infection/Acquired Immunodeficiency Syndrome: Changing epidemiology; diagnostic criteria and methods; management protocols

“…In cases that do not respond to fluconazole, a culture is recommended to identify the resistant strain and antifungal sensitivity of candida. In HIV‐infected patients, challenges that have to be overcome are development of drug resistance, biofilm formation, and the underlying immune deficiency of the host . Thus, in HIV‐infected patients, the primary focus should be to prevent the onset of disease rather than facilitate the onset of drug resistance due to frequent use of antifungals.…”

“…Houttuynia cordata extract, another plant‐derived product, apart from regulating mucosal innate immunity, has antimicrobial activities against Candida albicans . Herbal products show promise in the management of OC and need to be studied further …”