ORAL CANDIDA COLONIZATION AND INFECTION IN HIV-INFECTED PATIENTS IN A REFERRAL CENTER IN MEXICO CITY

Abstract

Objective To determine the species-specific virulence profile of Candida species isolated from the buccal mucosa of patients with HIV/AIDS and its association with clinical, laboratory and fluconazole resistance characteristics. Findings Cross-sectional, observational and analytical study. Saliva samples were obtained by swab and mouthwash of 118 HIV/AIDS adult patients and 74 individuals without HIV (comparative group). Ninety one percent (108) HIV/AIDS individuals were male, with a median age of 39.5 (Q1-Q3: 34-37) years, similar to the comparative group (median 35.5, Q1-Q3: 24-47, p=0.08). Sixty-two (53.4%) of HIV patients were in AIDS category, 91 (76%), used HAART, with a median use of 1,117 (Q1-Q3: 515-2,054) days. The median CD4+ lymphocyte count was 406 (Q1-Q3: 198-614) cells/mm3), 81(70.4%) subjects had undetectable viral load. The prevalence of oral candidosis (OC) was (9, 7.6%). Approximately one third were colonized (38, 32.2%). The most frequent species was C. albicans (86%), followed by C. glabrata. Similar findings were found in the comparative group: 5 (6.8%) OC patients, 19 (26.4%) colonized and a frequency of C. albicans of 84.2% (16). All HIV/AIDS patients with OC, had a count >400 colony forming units (CFU), contrasting the comparative group, where only 60% of OC individuals had ≥400 CFU. There was a frequency of resistance to fluconazole in 39.5% of HIV/AIDS patients, with a greater proportion in the colonized (41.2%) compared to the infected (33.3%). Conclusion Despite the decrease in the frequency of HIV-related oral lesions in the post-HAART era, OC continues to be a common infection. A high prevalence of colonization was found in both HIV and non-HIV participants, but CFU count was higher in the HIV patients. A high frequency of resistance to fluconazole was observed in the colonized with a high proportion of species non-albicans. Clinicians should consider the elevated resistance to antifungals for the treatment of OC.