Oral mycoses and other opportunistic infections in HIV: therapy and emerging problems – a workshop report

Abstract

Oral mycoses and other opportunistic infections are recognized features of HIV infection even after four decades of the epidemic. The therapeutic options, challenges of therapy, and evolving patterns of opportunistic infections were evaluated by the workshop. It was observed that high Candida counts and infection are still more prevalent in HIV‐positive individuals even in the era of antiretroviral therapy. Furthermore, one or more non‐Candida albicans are present in some HIV‐positive individuals. While Candida species are more virulent in HIV infection, similar virulence may be present in other states of immunosuppression. Consequently, the interplay between host factors and virulence ultimately determines the clinical outcomes. Adverse clinical outcomes such as candidemia and other deep fungal infections are on the increase in HIV infection. Disseminated histoplasmosis and penicilliosis have been reported, especially with low CD4 counts. Even with advances in antifungal therapy, mortality and morbidity from deep fungal infections have not changed significantly. In addition, long‐term exposure to common antifungal drugs such as fluconazole has led to the development of antifungal resistance in 6% to 36%. Development of new antifungal therapeutic agents and the use of alternative therapies may offer breakthrough. In addition, effective strategies to enhance the host immune status are being explored.

Oral Candidiasis: A Disease of Opportunity

“…It is well established that HIV + patients harbor increased levels of Candida colonizing the oral cavity and are significantly predisposed to OC [101]. Specifically, C. dubliniensis was recognized to have a strong proclivity for causing OC in HIV + patients [101] with the corollary that cluster of differentiation 4 (CD4) T-cell levels are directly proportional to the severity of OC in this patient population [102].…”

“…It is well established that HIV + patients harbor increased levels of Candida colonizing the oral cavity and are significantly predisposed to OC [101]. Specifically, C. dubliniensis was recognized to have a strong proclivity for causing OC in HIV + patients [101] with the corollary that cluster of differentiation 4 (CD4) T-cell levels are directly proportional to the severity of OC in this patient population [102]. Furthermore, HIV + patients have significantly lower protective levels of antimicrobial peptides, namely, histatin-5 (Hst-5); thus, these patients are reported to have increased rates of OC compared to matched healthy controls [87].…”

In Vitro Effect of Cinnamomum zeylanicum Blume Essential Oil on Candida spp. Involved in Oral Infections

“…However, local or systemic alterations might cause an imbalance in the host, predisposing the host to the development of disease, which might range from superficial and localized involvement to a fatal condition when it disseminates across the body of immunocompromised individuals [ 1 ]. The oral manifestations of the disease are considered signs indicative of an immune response imbalance, particularly among patients with acquired immunodeficiency syndrome [ 2 ].…”

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

“…Deep and invasive mycoses, such as invasive candidiasis, histoplasmosis, penicilliosis, sporotrichosis, coccidiomycosis, cryptococcosis, aspergillosis and blastomycosis have been reported in HIV‐positive patients . The deep mycoses are considered to be one of the major causes of mortality in HIV‐infected patients . Penicillium marneffei infection has been reported in patients with CD4 + counts less than 50 cells/μL, and the occurrence of this infection in patients with advanced HIV infection is invariably fatal without appropriate management …”