Oropharyngeal candidiasis and Candida colonization in HIV positive patients in northern India

Abstract

Introduction: Oropharyngeal candidiasis (OPC) is the most common opportunistic fungal infection reported in human immunodeficiency virus (HIV) positive patients worldwide. This prospective study was undertaken to investigate OPC and Candida colonization (CC) and their correlation with CD4⁺ cell counts and antiretroviral therapy (ART) in HIV-positive patients.

Methodology: In total, 190 HIV-positive patients were enrolled for study in three groups as follows: Group A, 90 patients without ART; Group B, 100 patients undergoing treatment with ART; and Group C, 75 HIV-negative control patients. All HIV patients underwent clinical examination and were subjected to CD4⁺ cell counts. Swabs were collected from the oral cavity of all individuals and plated on Sabouraud’s dextrose agar. Identification of Candida species was performed by conventional methods.

Results: Candida species were isolated in 84/190 (44.2%) and 20/75 (26.6%) of the HIV-positive subjects and controls respectively (p<0.01). OPC was noted in 21/190 (11%) of the HIV-positive patients. Candida albicans was the most frequently isolated species. Patients with CD4⁺ cell counts ≤ 200 cells/mm³ were significantly (p<0.001) more frequently colonized (37/63; 58.7%) and infected (18/21; 85.7 %) with Candida species. Candida species was seen in patients with CC and OPC with CD4⁺cell counts between 201 and 500 (21/63; 33.4% vs 3/21; 14.3%) and > 500 cell/mm³ (5/63; 7.9% versus 0/21 0%) respectively.

Conclusion: OPC and Candida colonization occur more frequently in HIV-positive patients with CD4⁺ cell counts ≤200 cell/mm³. ART significantly reduces OPC. C. albicans is the most frequently isolated species in both OPC and colonization, suggesting endogenous infection.