A study of oral candidiasis in HIV-positive patients.

PURPOSE: Candidiasis may occur as the first clinical sign or symptom of HIV disease. Oral candidiasis was studied with respect to immunological status, and response to antifungal therapy in a group of HIV-positive individuals with a history of recurrent oral candidal infections.

METHODS

Yeast cultures were obtained from 16 HIV-positive patients and identified and quantitated on a weekly basis until the infection was controlled. Thereafter, cultures were taken monthly or when recurrences occurred for a minimum of three to a maximum of 15 months. Ketoconazole and fluconazole were administered to control clinical signs and symptoms, which were evaluated by appearance and location in the oral cavity. Culture smears were quantitated by colony-forming units (CFUs) on dextrose agar plates. Individual patient medical histories included current medications, the presence of xerostomia, smoking habits, and denture wear. Frequency data only are reported due to the small number of patients included in the study.

RESULTS

The presence of clinical lesions coincided with increased colony-forming units, and a combination of pseudomembranous and erythematous lesions was the most prevalent. Frequently, a patient's lesions had the same clinical appearance as previous episodes involving the same oral sites. However, the presence of Candida cannot be accurately assessed by clinical signs alone since high CFU counts were found in patients demonstrating no clinical signs or symptoms.

CONCLUSIONS

An increasing yeast burden in the oral flora may result from a combination of local factors such as smoking, xerostomia, antibiotic or antiviral medication, and decreasing cell mediated immunity leading to immune tolerance towards Candida. Negative cultures following antifungal treatment most likely reflect a diminished yeast population rather than eradication of Candida. Subclinical Candida in the oral flora warrants consideration in prophylactic treatment options for the HIV-positive patient.