Recurring Candida albicans esophagitis in a HIV-infected patient undergoing long-Term antiretroviral therapy, and with absent-negligible immunodeficiency

Abstract

A patient with HIV infection developed the first episode of AIDS-defining opportunism (severe Candida albicans esophagitis) with an underlying CD4+ lymphocyte count of 1,025 cells/μ μ μ μ μL. After treatment with a highly active antiretroviral therapy (HAART), taken with insufficient compliance and leaving a residual viral load, our patient suffered from two relapses of esophageal candidiasis, which occurred three months and seven years later, when his CD4+ lymphocyte count was 930 and 439 cells/μ μ μ μ μL, respectively, and a viral load slightly above 10 4 copies/mL was still present. Also in the HAART era, Candida esophagitis remains one of the most common AIDS-defining diseases, but a presentation with a concurrent CD4+ count above 1,000 cells/μ μ μ μ μL remains a rare exception, as well as the two isolated, subsequent relapses, occurred with a CD4+ count ranging from 439 to 930 cells/μ μ μ μ μL, and a residual HIV viremia due to insufficient adherence to the prescribed HAART regimens. Our case report represents the opportunity to revisit the epidemiology and, especially, the pathogenesis of this opportunistic fungal complication in HIVinfected patients and in other subjects at risk, on the ground of an extensive literature review, and to explore possible alternative supporting factors other than the crude absolute CD4+ lymphocyte count, with emphasis on the possible role of a persisting HIV viremia, and other potential contributing factors. Clinicians engaged with immunocompromised patients and subjects with HIV disease, should be aware that a Candida esophagitis may occur and relapse also when the cell-mediated immunity, as measured by a simple CD4+ cell count, do not show relevant abnormalities.

Factors Associated with Esophageal Candidiasis and Its Endoscopic Severity in the Era of Antiretroviral Therapy

“…However, their study did not consider the history of HAART or the presence of asymptomatic patients. Manfredi and colleagues [17] speculate that high HIV-RNA VL is an important factor associated with the recurrence of CE, regardless of immune status.…”

A Groundhog, a Novel Bartonella Sequence, and My Father's Death

“…Endoscopy performed on December 26 identified severe necrotizing esophagitis, multiple plaques, and a stricture attributed to Candida albicans and herpes zoster. C. albicans esophagitis is known to accompany HIV infection, leukemia, or an unidentified source of immune suppression ( 1 , 2 ). Shingles, caused by herpes zoster, occurred during the previous Thanksgiving and can be associated with immunosuppression, stress, or an aging immune system ( 3 , 4 ).…”

Antifungal Applications of Ag‐Decorated Hydroxyapatite Nanoparticles

“…Hence, the risk of infectious complications is high and may lead to failures which entail the need for subsequent surgery and medical costs in addition to the pain and suffering of patients. Candida albicans is among the most frequently isolated microorganisms from human infections, mainly in immunocompromised patients [4][5][6]. Although C. albicans is an eukaryotic commensal microorganism of human mucosal surfaces, when there is impairment of the host immunity, it can cause serious superficial and deep infections [4].…”