Dynamic Study Of Oral Candida Infection And Immune Status In HIV/AIDS Patients During Highly Antiretroviral Therapy

Objectives:Acquired immunodeficiency syndrome(AIDS)is a major public health problem in the world,which is caused by human immunodeficiency virus(HIV)infection.Oral candidiasis(OC)is the most common oral lesion in HIV/AIDS patients.But the relationship between oral Candida infection and immune status in patients undergoing highly active antiretroviral therapy(HAART)is unclear.The objectives of this study were to monitor the dynamic changes of oral Candida infection and immune status in HIV/AIDS patients during HAART,and to explore the association between oral Candida infection and immune status of patients.Methods: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,medical history collection and oral examination were performed for each patient.The oral rinse samples were collected and cultured on sabourd’s dextrose agar for 2 days to determine oral Candida load.For the identification of oral Candida,Gram staining,CHROMagar Candida medium and 45℃growth test were used.Blood samples were collected to detect CD4~+T lymphocyte counts,CD8~+T lymphocyte counts and CD4/CD8 ratios by CD4 whole blood kits.Results:At baseline and 3,6 and 12 months after HAART,28,13,12and 13 patients had oral lesions,respectively,including OC,oral ulcer,oral hairy leukoplakia,cheilitis,glossitis and hairy tongue.The most frequent oral lesion was OC during the first year of HAART.At 3,6 and12 months after HAART,the number of patients suffering from OC was12,10 and 11 respectively,which was significantly lower than the baseline level of 24.At baseline and 3,6 and 12 months after HAART,27 strains,24strains,21 strains and 21 strains of Candida were isolated respectively.Candida albicans was the main isolated strain,accounting for 70.37%(19/27),70.83%(17/24),71.43%(15/21),71.43%(15/21),respectively.However,non-Candida albicans still accounted for a certain proportion of all isolated strains,and there was mixed colonization of Candida.At 3,6 and 12 months after HAART,CD4~+T lymphocyte counts of patients were 327.91±138.82 cells/mm~3,329.65±142.66 cells/mm~3 and319.98±97.90 cells/mm~3,respectively,which were significantly higher than the baseline level of 263.39±126.01 cells/mm~3.At baseline and 3 and6 months after HAART,CD8~+T lymphocyte counts of patients were878.48±487.31 cells/mm~3,720.63±303.35 cells/mm~3 and 739.13±384.71cells/mm~3,respectively,which were significantly higher than that at 12months after HAART(470.91±155.45 cells/mm~3).At 3,6 and 12 months after HAART,CD4/CD8 ratios of patients were 0.49±0.21,0.47±0.14,0.73±0.28 respectively,which were significantly higher than the baseline level of 0.36±0.23.At 3 months after HAART,oral Candida load was negatively correlated with CD4~+T lymphocyte counts in HIV/AIDS patients.At 3and 6 months after HAART,oral Candida load was negatively correlated with CD4/CD8 ratios in HIV/AIDS patients.At baseline and 3,6 and 12 months after HAART,CD4~+T lymphocyte counts and CD4/CD8 ratios were lower in patients with OC.Except for the baseline,there were significant differences at the other three time points during the first year of HAART.During the first year of HAART,the association between OC and CD8~+T lymphocyte counts was unclear.During the first year of HAART,the oral Candida load of patients with OC was higher than that of patients without OC,and the difference was statistically significant.Through logistic regression analysis,it was found that CD4~+T lymphocyte counts<200 cells/mm~3 and Candida load≥300 CFU/mL were risk factors of OC at 3,6 and 12 months after HAART.Conclusions:(1)HAART can restore the immunity of HIV/AIDS patients and reduce the prevalence of OC.(2)Candida albicans was the main isolated strain.However,the proportion of non-Candida albicans in isolated strains and the mixed colonization of Candida cannot be ignored.(3)After HAART,the occurrence of OC was related to low CD4~+T lymphocyte counts,low CD4/CD8 ratios and high oral Candida load,and CD4~+T lymphocyte counts<200 cells/mm~3 and oral Candida load≥300CFU/mL may increase the risk of OC.(4)OC could be a marker of immunosuppression in HIV/AIDS patients,and routine oral examination is of great significance.