Abstract
Oral candidiasis remains a common problem in HIV-infected individuals, especially in sub-Saharan Africa. Here, we performed the first study in Chad on the prevalence of oral yeasts carriage and oral candidiasis in HIV-positive subjects from southern Chad and analyzed the influence of HAART, CD4+ T-cell numbers, and antimycotics in 589 patients. These patients were recruited from a specialized medical center for HIV patients in Sarh and from a rural medical health dispensary in the vicinity, including a total of 384 HIV-positive and 205 HIV-negative individuals. Yeasts obtained from oral specimen were identified by MALDI-TOF MS and their antifungal susceptibility profiles determined. The overall prevalence of yeast colonization and symptomatic oral candidiasis in HIV-infected patients was 25.1%. The prevalence of oral candidiasis was higher in untreated than in HAART-treated HIV-positive patients (16% vs. 2%; p < 0.01). Oral candidiasis was furthermore associated with high fungal burdens of Candida albicans and a CD4+ T-cell number <200/μl. A shift toward non-albicans Candida species was observed under nucleoside-based HAART therapy. Azole antifungal drug resistance was only observed for the intrinsically resistant species Candida krusei and Candida glabrata. Prevalence of oral candidiasis in the studied area was very low. The species distribution was similar to other countries around the world, with C. albicans being dominant. Candida dubliniensis was not isolated. Nucleoside-based HAART therapy significantly reduced oral colonization as well as occurrence of oral candidiasis caused by C. albicans and led to a species shift toward non-albicans species. Antifungal resistance was not yet a concern in Chad.
Highlights
Oral candidiasis is one of the most common oral lesions associated with human immunodeficiency virus infection (Holmberg and Meyer, 1986; Phelan et al, 1987; Barr, 1992; Laskaris et al, 1992; Greenspan et al, 2000; Leao et al, 2009; Chopra and Arora, 2012)
This bias is similar to reports from other African countries (Hamza et al, 2008; Agwu et al, 2012; Tami-Maury et al, 2012; Kwamin et al, 2013; Konate et al, 2017; Ambe et al, 2020), since women are more often affected by HIV than men and more likely to consult the local health care system (UNGASS, 2008; UNAIDS, 2009)
In the 1970s C. albicans was identified in all patients presenting with median rhomboid glossitis giving evidence that MRG is caused by chronic fungal infection (Cooke, 1975; Wright, 1978)
Summary
Oral candidiasis is one of the most common oral lesions associated with human immunodeficiency virus infection (Holmberg and Meyer, 1986; Phelan et al, 1987; Barr, 1992; Laskaris et al, 1992; Greenspan et al, 2000; Leao et al, 2009; Chopra and Arora, 2012). Candida albicans is a commensal of the human gastrointestinal tract and oral mucosa It is the most common yeast causing oropharyngeal candidiasis (Schoofs et al, 1998), but other non-albicans Candida species have emerged in this context (De Bernardis et al, 1996; Powderly et al, 1998; Cartledge et al, 1999; Mushi et al, 2016, 2018; Ambe et al, 2020). Colonization of oral mucosal surfaces with yeasts such as C. albicans is closely correlated to symptomatic disease (oropharyngeal and esophageal candidiasis; Pappas et al, 2003) and latter one with the severity of cellular immunodeficiency, especially infected hosts with the HI virus (Mercante et al, 2006; Malele Kolisa et al, 2019). In a resource-poor setting without access to CD4+ T-cell counting and HIV viral load measurements, oral candidiasis is one of the most important clinical markers of HIV infection, disease progression, CD4+ T-cell status (Fidel, 2006; Berberi et al, 2015), and can even give a hint to antiretroviral therapy failure (Hodgson and Rachanis, 2002; Ramirez-Amador et al, 2007)
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