HIV-related oral candidiasis in Nigerian children: A marker of HIV disease progression

Abstract

Background. Opportunistic infections such as oral candidiasis (OC) in HIV-infected children are generally seen with severe depression of the CD4+ count. Objectives . To evaluate usefulness of OC as a marker of disease progression in HIV-infected Nigerian children. Method . Newly diagnosed HIV-infected children, antiretroviral therapy (ART)-naive with oral lesions, attending a paediatric infectious diseases unit in Nigeria from July 2006 to June 2007 were enrolled. Clinical OC was registered if the attending physicians observed a seudomembranous oral lesion. The Dynal beads technique (Dynal Biotech, Oslo, Norway) was used for CD4 counting. CD4 counts were categorised using the Centers for Disease Control and Prevention classification. Results. The study population comprised 78 HIV-infected children aged 4 - 90 months (mean 20.54±7.23 months) with a male/female ratio of 1.05:1. The prevalence of OC was 20.5% (16 cases) in the study population. The median CD4 count of children with HIV-associated OC is within the severe immunosuppression level for age group, while all children without OC had median CD4 counts above the severe immunosuppression level for age group (p=0.000). Reliability of OC as a surrogate marker of severe immunosuppression yielded a modest sensitivity, high specificity and positive predictive value (44.44%, 92.15% and 75%, respectively). Conclusion . The high prevalence of OC in HIV-positive children was confirmed. The significant relationship of OC with severe immunosuppression suggests that in settings in which CD4 counts are not available, OC may be considered as a clinical surrogate for severe CD4 depletion. However, the absence of OC does not necessarily exclude severe immunosuppression.