Smoking as a risk factor for oral candidiasis in HIV‐infected adults

Abstract

Objective We aimed to examine if smoking is an independent predictor of oral candidiasis (OC) among HIV-1 infected persons. Methods The cross-sectional part of this study evaluated 631 adult dentate HIV-1 seropositive persons examined for OC from 1995 – 2000 at the University of North Carolina Hospitals in Chapel Hill, NC. In the second part, from the above sample, 283 individuals who were free of HIV-associated oral diseases at baseline were followed up for two years to assess incident OC events. Data collected from medical record review, interview questionnaires and clinical examinations were analyzed using chi-square tests and t-tests. Logistic regression models were developed for prevalent OC employing the likelihood ratio test, whereas Poisson regression models were developed for assessing cumulative incidence of OC. These models included a variety of independent variables to adjust for confounding. Results Thirteen percent of participants had OC only; 4.6% had OC with Oral Hairy Leukoplakia; and 69.7% had neither. Smoking was associated with OC in all models [prevalent OC - current smokers: logistic regression – Odd Ratio (95% CI) = 2.5 (1.3, 4.8); Incident OC - current smokers: Poisson regression (main effects model) - Incidence Rate Ratio (95% CI) = 1.9 (1.1, 3.8)]. Other Poisson regression models suggested evidence for effect modification between CD4 cell count and incident OC by smoking. Conclusion Smoking is an independent risk factor for development of OC in HIV-1 infected persons and the risk of OC is modified by CD4 cell count which measures strength of the immune system.

Clinical manifestations and risk factors for oral immune reconstitution inflammatory syndrome in Mexico

“…In this retrospective cohort, like others (Gaitan et al., 2008) described that oral candidiasis represented the most frequent lesion associated with IRIS, which has been reported in frequencies that vary from 17.3 (Novak et al., 2012) to 26.1% (Thambuchetty et al, 2017). The marginal association found between tobacco consumption and IRIS‐OL group should be carefully considered, since tobacco is an independent factor for oral candidiasis development, especially in PLWH with low CD4 counts (Chattopadhyay & Patton, 2013). It has been evidenced that the in vitro exposure to cigarette smoke increases the enzymatic activity of fungus, favoring Candida sp.…”

Current strategies for prevention of oral manifestations of human immunodeficiency virus

“…34 Smoking cessation should be recommended to all HIV-infected current smokers, because smoking has been shown to be an independent risk factor for the development of OC. 35 Using multiple logistic regression models controlling for use of HAART and antifungals, in HIV infected women, the presence of OC was associated with CD4 <200 cells/mm 3 , cigarette smoking, and heroin and methadone use. 36 Candida has been shown to colonize carious dentinal tubules more frequently in HIVpositive (77% of 30) than HIV-negative (17% of 30) subjects, suggesting that unrestored dentinal caries may serve as a protected niche for candida.…”

Innovations for prevention and care of oral candidiasis in HIV‐infected individuals: Are they available?—A workshop report

“…Oral candidiasis‐immune reconstitution inflammatory syndrome deserves a specific criterion, in which the clinical characteristics must be described as well as an emphasis to rule out other systemic and local predisposing factors related to OC (Lalla, Patton, & Dongari‐Bagtzoglou, 2013). In HIV/AIDS, smoking is an independent risk factor for OC, particularly among those with low CD4 cell counts (Chattopadhyay & Patton, 2013) and xerostomia and reduced saliva production may predispose to OC (Patton, 2016).…”