Dynamic study of oral Candida infection and immune status in HIV infected patients during HAART

https://doi.org/10.1016/j.archoralbio.2020.104741Get rights and content

Highlights

  • HIV is a major global health problem. Oral candidiasis (OC) is the most common oral manifestation of HIV infected individuals.

  • HAART has been considered as the gold standard in the treatment for HIV/AIDS patients, which reduces the viral load and increases CD4+ T lymphocytes in individuals living with HIV. However, HIV/AIDS patients with HAART can’t completely avoid oral Candida infection.

  • CD4/CD8 ratios can independently predict the time to death and non–AIDS-defining endpoints and is useful in monitoring response to HAART.

  • The majority of studies concerning HIV, immunity and OC are carried out in developing countries, but there are few studies on this issue in China.

  • Little attention has been paid to the relationship between OC and CD4/CD8 ratios and CD8+ T lymphocyte counts, and the relationship between OC and CD4+ T lymphocyte counts in patients undergoing HAART is not clear. There is little research on the dynamic changes of oral Candida infection and immune status in HIV infected people undergoing HAART.

Abstract

Objective

To dynamically monitor oral Candida infection, CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios in HIV/AIDS patients during their first year of HAART and to preliminarily explore the relationships between them.

Design

Forty-six patients with HIV/AIDS receiving HAART at the Infection Department of Chongqing Red Cross Hospital were followed for one year. At baseline and 3, 6, and 12 months after HAART initiation, oral rinses were collected and cultured to identify Candida species. Further, blood samples were collected to detect CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios.

Results

The prevalence of OC decreased after HAART initiation (P < 0.05), and Candida albicans was the dominant species isolated from the oral cavity (66/93). At 3, 6 and 12 months after HAART initiation, CD4+ T lymphocyte counts were 327.91 ± 138.82, 329.65 ± 142.66 and 319.98 ± 97.90 cells/mm3, respectively, which were significantly higher than the level at baseline (263.39 ± 126.01 cells/mm3) (P = 0.016, P = 0.014, and P = 0.035, respectively). During the first year of HAART, CD4/CD8 ratios increased gradually, and CD8+ T lymphocyte counts decreased continually. OC was associated with low CD4+ T lymphocyte counts and a low CD4/CD8 ratio. CD4+ T lymphocyte counts <200 cells/mm3 and Candida load ≥300 CFU/mL were risk factors for OC (P < 0.05), and oral Candida load was negatively correlated with CD4+ T lymphocyte counts and the CD4/CD8 ratio.

Conclusion

OC might be a useful marker for the evaluation of immune status in patients with HIV/AIDS.

Section snippets

Background

Acquired Immunodeficiency Syndrome (AIDS) is caused by the Human Immunodeficiency Virus (HIV), and it is characterized by a decrease in CD4+ T lymphocyte count. Since the first case of HIV infection was reported in 1981, there has been a continuous increase in the number of HIV infected patients. Since the introduction of highly active antiretroviral therapy (HAART), the incidence of opportunistic infections and HIV-related oral lesions has markedly decreased (de Almeida, Lima, Ziegelmann,

Patients

This prospective cohort study was approved by the Ethics Committee of Stomatology Hospital of Chongqing Medical University. Fifty patients with HIV/AIDS who were beginning HAART were recruited from the Infection Department of Chongqing Red Cross Hospital from February 2018 to July 2018, and all patients were followed up for one year. Oral examinations and blood sample collections were performed at baseline and 3, 6, and 12 months after HAART initiation. The inclusion criteria were as follows:

General characteristics of patients

A total of 50 patients with HIV/AIDS were included in this study, and 46 patients completed one year of follow up. Reasons for the loss to follow-up were as follows: 1 patient died of pulmonary tuberculosis during treatment, 2 patients withdrew from treatment, and 1 patient withdrew from the study because he could not follow up on time.

Of the 46 HIV positive patients, 40 were male and 6 were female. Ages ranged from 17 to 71 years, with a median age of 35 (IQR:22) years. The most common mode of

Discussion

Many studies have investigated OC and immune status in HIV infected patients (Jha, kaur, & Sharma, 2014; Jiang et al., 2014), although no study has described in detail or explored the relationships between the dynamic changes in the incidence of oral Candida infection, CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and the CD4/CD8 ratio.

Candida is a common opportunistic pathogen. At present, more than 200 species have been documented, including C. albicans, C. tropicalis, C. krusei, C.

Conclusion

The dynamic changes in oral Candida infections and immune status in HIV/AIDS patients during the first year of HAART were analysed to determine a preliminary exploration of the relationship. The prevalence of OC and oral Candida colonization decreased during the first year of HAART. C. albicans was the dominant species isolated from the oral cavity of included patients, and during the first year of HAART, the CD4+ T lymphocyte counts and CD4/CD8 ratios increased gradually while the CD8+ T

Author statement

Each coauthor has seen and agreed with each of the changes made to this manuscript in the revision and agreed to the way his or her name is listed.

Contributors

Xian Du developed the proposal, performed experiments, analysed data, and prepared the manuscript. Yao Yang and Hui Xiong performed experiments, and analysed data, and prepared the manuscript. Jihui Yan and Shuqiong Zhu assisted in oral sample collection. Fangchun Chen designed the study, directed the project, advised experiments, interpreted the results and revised the manuscript.

Funding

This paper was supported by the Key Project of Medical Research of Chongqing Health and Family Planning Commission (2016ZDXM020).

Declaration of Competing Interest

There are no conflicts of interest.

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