Epidemiology and Prevalence of Oral Candidiasis in HIV Patients From Chad in the Post-HAART Era

Abstract

Oral candidiasis remains a common problem in HIV-infected individuals, especially in sub-Saharan Africa. Here, we performed the first study in Chad on the prevalence of oral yeasts carriage and oral candidiasis in HIV-positive subjects from southern Chad and analyzed the influence of HAART, CD4+ T-cell numbers, and antimycotics in 589 patients. These patients were recruited from a specialized medical center for HIV patients in Sarh and from a rural medical health dispensary in the vicinity, including a total of 384 HIV-positive and 205 HIV-negative individuals. Yeasts obtained from oral specimen were identified by MALDI-TOF MS and their antifungal susceptibility profiles determined. The overall prevalence of yeast colonization and symptomatic oral candidiasis in HIV-infected patients was 25.1%. The prevalence of oral candidiasis was higher in untreated than in HAART-treated HIV-positive patients (16% vs. 2%; p < 0.01). Oral candidiasis was furthermore associated with high fungal burdens of Candida albicans and a CD4+ T-cell number <200/μl. A shift toward non-albicans Candida species was observed under nucleoside-based HAART therapy. Azole antifungal drug resistance was only observed for the intrinsically resistant species Candida krusei and Candida glabrata. Prevalence of oral candidiasis in the studied area was very low. The species distribution was similar to other countries around the world, with C. albicans being dominant. Candida dubliniensis was not isolated. Nucleoside-based HAART therapy significantly reduced oral colonization as well as occurrence of oral candidiasis caused by C. albicans and led to a species shift toward non-albicans species. Antifungal resistance was not yet a concern in Chad.

Molecular Mapping of Antifungal Mechanisms Accessing Biomaterials and New Agents to Target Oral Candidiasis

“…As a part of the gastrointestinal tract, the oral cavity is usually a pleasant environment for commensal microorganisms in the absence of health imbalances [ 18 ]. Mycotic infection of the oral mucosa acts as an invasive pathology that involves the development of opportunistic pathogens in the structure of the healthy tissue of the host.…”

“…A decrease in histatins level contributes to the severity of the pathology. [18,21,40] Prolonged antibiotherapy Administration of broad-spectrum antibiotics yields dysbiosis, affecting the normal oral flora and transforming the commensal microorganisms into pathogenic entities. Imbalances in oral microbiota were related to a decrease in salivary antibody content.…”

Epidemiology, prevalence, and associated factors of oral candidiasis in HIV patients from southwest Iran in post-highly active antiretroviral therapy era

“…OC diagnosis is essentially clinical, which is based on appearance and risk factors; isolation and identification of the causative yeast species is mostly done to confirm the diagnosis and select the appropriate treatment (Loo, 2009;Coronado-Castellote and Jiménez-Soriano, 2013). Candida albicans is the most commonly implicated species in OC (Taverne-Ghadwal et al, 2022), followed by C. glabrata, C. tropicalis, and C. dubliniensis Abbreviations: OC, oral candidiasis; PLWHA, people living with HIV/AIDS; HAART, highly active antiretroviral therapy; NAC, non-albicans Candida; BDCC, Behavioral Diseases Counseling Center; OR, odds ratios; CI, 95% confidence intervals; BMI, body mass index.…”

“…In many developing countries such as Iran, OC treatment is performed without accurate diagnosis of Candida spp. and is only based on clinical signs (Taverne-Ghadwal et al, 2022). On the other hand, the prevalence of Candida spp.…”

Repurposing HIV Protease Inhibitors Atazanavir and Darunavir as Antifungal Treatments against Candida albicans Infections: An In Vitro and In Vivo Study

“…Furthermore, candidiasis is frequent among immunodeficient individuals, with oral candidiasis indicative of untreated human immunodeficiency virus (HIV) infection [ 5 ]. However, since the introduction of the first generation of HIV protease inhibitors (HIV-PI) in highly active antiretroviral therapy (HAART), the prevalence of candidiasis in HIV-infected individuals has reduced [ 6 ].…”