Immunological and epidemiological factors affecting candidiasis in HIV patients beginning antiretroviral therapy in an Asian clinic

- Oropharyngeal candidiasis (OPC) is common in HIV patients beginning ART.
- We present a study of 82 ART naïve HIV-infected adults beginning ART with <200 CD4+ T-cells/μl in Jakarta.
- At baseline, OPC in 47 patients was linked with a high burden of culturable fungi. ART decreased the prevalence of OPC and their fungal burdens.
- Salivary β-defensin-2 was elevated in the presence of C. albicans or OPC after 3 months on ART, but β-defensin-3 was not affected by OPC or ART.

ObjectivesOropharyngeal candidiasis (OPC) is common in HIV patients beginning antiretroviral therapy (ART). Here we address the response to ART, and the roles of poor oral hygiene and defects in local innate immunity with a focus on salivary β-defensins, as they are implicated in control of candidiasis but have not been investigated in this context.DesignART naïve HIV-infected adults (n = 82) with <200 CD4+ T-cells/mm3 attending clinics at Cipto Mangunkusumo Hospital, Jakarta, were examined at the commencement of ART, and 73 were re-examined after 3 months. OPC was detected by clinical examination, and Candida albicans and fungal burdens were determined following culture on CHROMagar and saboroud-dextrose agar (resp). Salivary β-defensins (−2 and −3) were quantified by ELISA. Healthy control subjects (n = 40) matched the patients by age and gender.ResultsOPC was evident in 47 patients before ART, and associated with greater fingal burdens. No OPC was detected in healthy controls and culture positivity was rare. ART decreased the prevalence of OPC to 8/73 HIV patients re-examined after 3 months, with reduced total fungal and C. albicans burdens. The incidence of OPC was independent of oral hygiene. Hyposalivation was more common in untreated HIV patients (16%) than after 3 months on ART and was rare in healthy controls. HIV patients were also more likely to have acidic saliva. Salivary β-defensin-2 was elevated in the presence of C. albicans pseudohyphae and OPC after 3 months on ART, but β-defensin-3 was not affected by OPC or ART.ConclusionsART reduces the prevalence of OPC, and the total fungal and C. albicans burden. Levels of salivary β-defensin-2 may associate with OPC in HIV patients responding to ART.