Oral manifestations, salivary flow rates and Candida species in Thai HIV-infected patients.

K Sappayatosok,A Lam-ubol,S Rungsiyanont,P Vacharotayangul,O Chankanka

doi:10.4317/jced.55384

Abstract

BackgroundEffects of various Highly Active Antiretroviral Therapy (HAART) regimens on oral heath are unclear. Objectives: We aimed to evaluate effects of HAART on oral manifestations, salivary flow rates (SFR) and Candida species in HIV-infected patients who took mostly non-protease inhibitor-based HAART regimens.Material and MethodsA cross-sectional study was performed on HIV-infected patients taking and never taken HAART who attended Thai Red Cross AIDS Research Centre (n = 48). Non-HIV subjects were recruited as control (n = 20). Oral conditions and salivary flow rates were evaluated using oral examination and measurement of unstimulated and stimulated saliva. In addition, Candida colonization counts (colony forming units; CFUs) and Candida species from the collected saliva were evaluated using CHROMagar.ResultsThe most common oral manifestation in HIV-infected subjects taking HAART was hyperpigmentation. Unstimulated and stimulated SFR among the three groups were not statistically significant. Candida colonization was detected in 64%, 65% and 35% of HIV-infected subjects taking HAART, HAART-naïve, and non-HIV subjects, respectively. While 20% and 35% of HIV-infected subjects with and without HAART, respectively, had Candida CFUs higher than 500/ml, all non-HIV carriers had Candida CFUs lower than 500/ml. The most common Candida colonization species was C. albicans in HAART and non-HIV groups. Interestingly, HAART-naïve group was colonized more by non-albicans species.ConclusionsHAART has minimal effects on oral health. While HAART may not prevent Candida colonization, it might lead to reduction of non-albicans species. Because maintaining low Candida counts is important, HAART administration and antifungal sensitivity test should be considered in HIV-infected patients. Key words:HIV, Candida, HAART, Oral manifestation, Salivary flow rates.

Highlights

Human Immunodeficiency Virus (HIV) infection has been one of the major public health problems
When we evaluated factors that might affects Candida colonization in each group, no statistically difference was found in any factors, including CD4 counts, years of HIV infections, years of Highly Active Antiretroviral Therapy (HAART) usage and salivary flow rates (Table 4)
We found that current HAART regimens in majority of our population were combination of NRTIs and nucleoside reverse transcriptase inhibitor (NNRTI), which were different than previously used PIs

Summary

Introduction

Human Immunodeficiency Virus (HIV) infection has been one of the major public health problems. Patients living with AIDS face other health problems such as lipodystrophy, cardiovascular diseases and cancers, due to the disease itself and side effects from HAART [4]. One of the most common opportunistic infection in HIV-infected patients, has been significantly reduced with HAART [1,2,3]. Effects of HAART on Candida colonization in HIV-infected patients is still controversial [8,9,10]. Oral cavity colonization by Candida species can be found in healthy population, percentage of Candida carriers in HIV-infected patients were reported to be higher than in healthy population [8]. Candida albicans is the most common species found in oral candidiasis and Candida colonization in HIV-infected subjects. Effects of HAART on Candida colonization and Candida species were unclear

Objectives

Findings

Discussion and conclusion