1
|
Lara VS, Silva RAD, Ferrari TP, Santos CFD, Oliveira SHPD. Losartan Plays a Fungistatic and Fungicidal Activity Against Candida albicans Biofilms: Drug Repurposing for Localized Candidosis. Assay Drug Dev Technol 2023; 21:157-165. [PMID: 37229625 DOI: 10.1089/adt.2023.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Candidosis is one of the most frequent opportunistic infections and exhibits variable clinical presentations, including oral localized forms. Drugs affecting the renin-angiotensin system targets inhibit secreted aspartic proteases from Candida albicans. The objective of the study was to evaluate whether losartan has antimicrobial action against C. albicans biofilms. Biofilms were treated with losartan or aliskiren (for comparison) for 24 h. Metabolic activity of viable cells and growth inhibition of C. albicans biofilms were assessed using XTT [2,3-Bis(2-Methoxy-4-Nitro-5-Sulfophenyl)-5-[(Phenyl-Amino)Carbonyl]-2H-Tetrazolium Hydroxide] and colony-forming unit assays, respectively. In addition, the cytotoxicity of the drugs on human cells was evaluated using the AlamarBlue assay. Both drugs decreased fungal viability at all concentrations. In addition, all concentrations of losartan inhibited the growth of C. albicans biofilm, ranging from 47% to 88.5%, whereas aliskiren showed inhibition from 1 to 10 mg/mL, which ranged from 16% to 97.6%. Furthermore, at certain concentrations, these drugs maintained the viability of human cells. Losartan and aliskiren have fungistatic and fungicidal action against C. albicans biofilms and are compatible with human cells. Therefore, these antihypertensive drugs can be repurposed to interfere with the metabolism and development of Candida biofilms, which are widely associated with clinical forms of candidosis, including oral localized forms such as denture stomatitis.
Collapse
Affiliation(s)
- Vanessa Soares Lara
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo (USP), Bauru, Brazil
| | - Rafaela Alves da Silva
- Integrated Research Center, Bauru School of Dentistry, University of São Paulo (USP). Bauru, Brazil
| | - Tatiane Ponteado Ferrari
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo (USP), Bauru, Brazil
| | - Carlos Ferreira Dos Santos
- Department of Biological Sciences, Bauru School of Dentistry, University of Sa˜o Paulo (USP). Bauru, Brazil
| | - Sandra Helena Penha de Oliveira
- Immunopharmacology Laboratory, Department of Basic Sciences, São Paulo State University (UNESP), School of Dentistry. Araçatuba, Brazil
| |
Collapse
|
2
|
Benslama L. Oral and maxillofacial manifestations of human immunodefficiency virus infection. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:622-633. [PMID: 35618625 DOI: 10.1016/j.jormas.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
Oral manifestations occur at all stages of human immunodeficiency virus (HIV) infection. Their clinical expressions and severity depend on the evolution of the infection and become critical at the stage of acquired immunodeficiency (AIDS). They are essentially infectious, tumoral, and, starting a few years ago, iatrogenic. Infections are mostly fungal (candidiasis), viral (herpes, zoster, human papillomavirus infections, etc.), and less frequently bacterial (streptococcemia). Cases of sexually transmitted diseases, particularly syphilis, are multiplying preoccupyingly. The most frequently observed tumors are Kaposi's sarcoma. Drug intolerance is common; the symptoms are mostly dermatological, but also oral (Stevens-Johnson syndrome and toxic epidermal necrolysis) when sulfonamides and certain antiretrovirals are used. The advent of prolonged Highly Active Anti-Retroviral Therapies (HAARTs) has led to a decline in the incidence of most opportunistic conditions, infections and tumors (except for multiple oral warts and zoster). HAARTs also provoke adverse reactions such as lipodystrophy syndromes (signs of peripheral atrophy and central hypertrophy, associated in varying degrees with metabolic syndromes). Extended survival and the new methods for prophylaxis of opportunistic infections have gradually modified diagnostic and therapeutic strategies for oral manifestations of HIV infections.
Collapse
Affiliation(s)
- L Benslama
- Department of stomatology and maxillofacial surgery, AP-HP, DHU FAST, GH Pitié- Salpêtrière- Charles Foix, Paris F-75013, France.
| |
Collapse
|
3
|
Kalimuthu S, Alshanta OA, Krishnamoorthy AL, Pudipeddi A, Solomon AP, McLean W, Leung YY, Ramage G, Neelakantan P. Small molecule based anti-virulence approaches against Candida albicans infections. Crit Rev Microbiol 2022; 48:743-769. [PMID: 35232325 DOI: 10.1080/1040841x.2021.2025337] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Fungi are considered "silent killers" due to the difficulty of, and delays in diagnosis of infections and lack of effective antifungals. This challenge is compounded by the fact that being eukaryotes, fungi share several similarities with human cellular targets, creating obstacles to drug discovery. Candida albicans, a ubiquitous microbe in the human body is well-known for its role as an opportunistic pathogen in immunosuppressed people. Significantly, C. albicans is resistant to all the three classes of antifungals that are currently clinically available. Over the past few years, a paradigm shift has been recommended in the management of C. albicans infections, wherein anti-virulence strategies are considered an alternative to the discovery of new antimycotics. Small molecules, with a molecular weight <900 Daltons, can easily permeate the cell membrane and modulate the signal transduction pathways to elicit desired virulence inhibitory actions against pathogens. This review dissects in-depth, the discoveries that have been made with small-molecule anti-virulence approaches to tackle C. albicans infections.
Collapse
Affiliation(s)
| | - Om Alkhir Alshanta
- Glasgow Endodontology Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - Akshaya Lakshmi Krishnamoorthy
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.,Quorum Sensing Laboratory, Centre for Research in Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
| | - Akhila Pudipeddi
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Adline Princy Solomon
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
| | - William McLean
- Glasgow Endodontology Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - Yiu Yan Leung
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Gordon Ramage
- Glasgow Endodontology Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | | |
Collapse
|
4
|
Seminario AL, Kemoli A, Benki-Nugent S, Chebet D, Gomez L, Wamalwa D, John-Stewart G, Slyker JA. Caregivers' report of HIV-associated oral manifestations among HIV-unexposed, exposed, and infected Kenyan children. Int J Paediatr Dent 2021; 31:708-715. [PMID: 33368736 PMCID: PMC9162147 DOI: 10.1111/ipd.12771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few oral health studies have been conducted in HIV-exposed uninfected children, who, like their HIV-infected peers, have altered immunity and perinatal drug exposures. AIM To compare caregiver' self-report of oral diseases, hygiene practices and utilization of routine dental care, between HIV-infected (HIV), HIV-exposed uninfected (HEU), and HIV-unexposed uninfected (HUU) children in Kenya. DESIGN This nested cross-sectional study was conducted at the Kenyatta National Hospital, Nairobi, Kenya. Caregivers of 196 children (104 HIV-infected, 55 HEU, and 37 HUU) participated in this study. Using a validated questionnaire from the WHO and photographs of HIV-related oral lesions, we collected data on oral diseases and oral health practices. RESULTS Caregivers of HIV-infected children reported at least one oral disease in their children (42%; HEU [27%]; HUU [17%; P = .008]). Oral candidiasis was the most common disease reported (HIV-infected [24%], HEU [5.5%], and HUU [2.8%; P < .05]). Baseline CD4% was associated with oral candidiasis (OR = 0.93, 95% CI: 0.88-0.98). Only 16% of children had ever visited a dentist, and most initiated brushing after 3 years of age (83%). Nearly all (98%) caregivers desired a follow-up oral examination. CONCLUSIONS HIV infection/exposure and low CD4% were associated with increased odds of oral diseases. Most caregivers desired a follow-up oral examination for their children.
Collapse
Affiliation(s)
- Ana Lucia Seminario
- Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Arthur Kemoli
- Department of Pediatric Dentistry & Orthodontics, University of Nairobi, Nairobi, Kenya
| | | | - Daisy Chebet
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Lauren Gomez
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA,Department of Pediatrics and Department of Medicine, University of Washington, Seattle, WA, USA,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jennifer A. Slyker
- Department of Global Health, University of Washington, Seattle, WA, USA,Department of Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
5
|
Dynamic study of oral Candida infection and immune status in HIV infected patients during HAART. Arch Oral Biol 2020; 115:104741. [PMID: 32417705 DOI: 10.1016/j.archoralbio.2020.104741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/18/2020] [Accepted: 04/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To dynamically monitor oral Candida infection, CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios in HIV/AIDS patients during their first year of HAART and to preliminarily explore the relationships between them. DESIGN 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 initiation, oral rinses were collected and cultured to identify Candida species. Further, blood samples were collected to detect CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios. RESULTS The prevalence of OC decreased after HAART initiation (P < 0.05), and Candida albicans was the dominant species isolated from the oral cavity (66/93). At 3, 6 and 12 months after HAART initiation, CD4+ T lymphocyte counts were 327.91 ± 138.82, 329.65 ± 142.66 and 319.98 ± 97.90 cells/mm3, respectively, which were significantly higher than the level at baseline (263.39 ± 126.01 cells/mm3) (P = 0.016, P = 0.014, and P = 0.035, respectively). During the first year of HAART, CD4/CD8 ratios increased gradually, and CD8+ T lymphocyte counts decreased continually. OC was associated with low CD4+ T lymphocyte counts and a low CD4/CD8 ratio. CD4+ T lymphocyte counts <200 cells/mm3 and Candida load ≥300 CFU/mL were risk factors for OC (P < 0.05), and oral Candida load was negatively correlated with CD4+ T lymphocyte counts and the CD4/CD8 ratio. CONCLUSION OC might be a useful marker for the evaluation of immune status in patients with HIV/AIDS.
Collapse
|
6
|
Ryder MI, Shiboski C, Yao TJ, Moscicki AB. Current trends and new developments in HIV research and periodontal diseases. Periodontol 2000 2020; 82:65-77. [PMID: 31850628 DOI: 10.1111/prd.12321] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the advent of combined antiretroviral therapies, the face of HIV infection has changed dramatically from a disease with almost certain mortality from serious comorbidities, to a manageable chronic condition with an extended lifespan. In this paper we present the more recent investigations into the epidemiology, microbiology, and pathogenesis of periodontal diseases in patients with HIV, and the effects of combined antiretroviral therapies on the incidence and progression of these diseases both in adults and perinatally infected children. In addition, comparisons and potential interactions between the HIV-associated microbiome, host responses, and pathogenesis in the oral cavity with the gastrointestinal tract and other areas of the body are presented. Also, the effects of HIV and combined antiretroviral therapies on comorbidities such as hyposalivation, dementia, and osteoporosis on periodontal disease progression are discussed.
Collapse
Affiliation(s)
- Mark I Ryder
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California, USA
| | - Caroline Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anna-Barbara Moscicki
- Division of Adolescent Medicine, Department of Pediatrics, University of California, Los Angeles, California, USA
| |
Collapse
|
7
|
The association between oral disease and type of antiretroviral therapy among perinatally HIV-infected youth. AIDS 2018; 32:2497-2505. [PMID: 30096069 DOI: 10.1097/qad.0000000000001965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study explores the association between combination antiretroviral therapy (cART) and oral health outcomes (dental and periodontal) among perinatally HIV-infected (PHIV) youth. METHODS We conducted a cross-sectional study of oral health among PHIV youth participating in the Oral Health substudy of the Pediatric HIV/AIDS Cohort Study (PHACS). Dentists at research sites were trained/calibrated on how to perform a standardized oral mucosal, dental and periodontal examination. They assessed the decayed-missing-filled-surfaces and teeth index (DMFS/T). The number of decayed surfaces and teeth and the number of teeth with gingival bleeding on probing for each participant were derived from the examination. Data for analysis included lifetime measurements of CD4 cell count and viral load, sociodemographic information and current/past history of ART. RESULTS Among 209 PHIV youth, 95% were on ART at the time of enrolment. Among 143 PHIV youth on the same cART for at least 1 year, we found that the mean decayed teeth score of those receiving cART containing an integrase inhibitor was 86% higher than that of those on cART without an integrase inhibitor after adjusting for age, lifetime proportion of unsuppressed viral load and CD4 cell count nadir. Initiating protease inhibitors before age 6 years was associated with a significantly lower DMFT score than participants who initiated at age 6 years and older. CONCLUSION Our study revealed that PHIV youth who received cART containing an integrase inhibitor had a significantly higher number of untreated active caries than those on cART without an integrase inhibitor. This may warrant closer dental surveillance of those receiving an integrase inhibitor.
Collapse
|
8
|
Greenspan D, Gange SJ, Phelan JA, Navazesh M, Alves MEAF, MacPhail LA, Mulligan R, Greenspan JS. Incidence of Oral Lesions in HIV-1-infected Women: Reduction with HAART. J Dent Res 2016; 83:145-50. [PMID: 14742653 DOI: 10.1177/154405910408300212] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Few studies assess the effectiveness of HAART on reducing the incidence and recurrence of oral lesions. We investigated such changes among 503 HIV+ women over six years in the Women’s Interagency HIV Study. The incidence of erythematous candidiasis (EC), pseudomembranous candidiasis (PC), hairy leukoplakia (HL), and warts was computed over follow-up visits after HAART initiation compared with before HAART initiation. Analysis of our data demonstrates a strong decrease in candidiasis after HAART initiation. The incidence of EC fell to 2.99% from 5.48% (RR 0.545); PC fell to 2.85% from 6.70% (RR 0.425); and EC or PC fell to 3.43% from 7.35% (RR 0.466). No changes were seen in HL or warts. Higher HIV-RNA was associated with greater incidence of candidiasis and HL, but not warts. Analysis of these data indicates that recurrence and incidence of candidiasis are reduced by HAART, and that recurrence is reduced independently of CD4 and HIV-RNA.
Collapse
Affiliation(s)
- D Greenspan
- Department of Stomatology, University of California San Francisco, San Francisco, CA 94143-0422, USA.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Hodgson TA, Naidoo S, Chidzonga M, Ramos-Gomez F, Shiboski C. (A1) Identification of Oral Health Care Needs in Children and Adults, Management of Oral Diseases. Adv Dent Res 2016; 19:106-17. [PMID: 16672560 DOI: 10.1177/154407370601900121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The workshop considered five questions reviewing the identification of international oral health care needs of children and adults, and the management of oral diseases in resource-poor countries: (1) What is the role of the dental profession in the management of the HIV-infected individual? (2) Identifying health care needs-What are the epidemiology and disparities of HIV-associated oral lesions in children from different continents? (3) How effective is HIV treatment in controlling oral diseases? (4) Could we develop basic inexpensive oral and dental care protocols for economically deprived HIV-infected patients? and (5) What is the best method of arranging resources to meet the oral health care needs of people with HIV disease? The consensus of the workshop participants was that there is a need to re-target research efforts to non-established market economy countries and prioritize research in these regions to children with HIV disease. It will be important to assess commonalities and variations in oral health needs across geographical and cultural boundaries, and research efforts should be centralized in resource-poor countries to support multi-center longitudinal standardized studies. It is essential that oral health research be integrated into other health care research programs, to make these research priorities and public health initiatives feasible.
Collapse
Affiliation(s)
- T A Hodgson
- Oral Medicine, Division of Maxillofacial Diagnostic, Medical and Surgical Sciences, UCL Eastman Dental Institute and UCLHT Eastman Dental Hospital, London, UK.
| | | | | | | | | |
Collapse
|
10
|
Hodgson TA, Greenspan D, Greenspan JS. Oral Lesions of HIV Disease and HAART in Industrialized Countries. Adv Dent Res 2016; 19:57-62. [PMID: 16672551 DOI: 10.1177/154407370601900112] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The epidemiology of HIV-related oral disease in industrialized nations has evolved following the initial manifestations described in 1982. Studies from both the Americas and Europe report a decreased frequency of HIV-related oral manifestations of 10–50% following the introduction of HAART (highly active antiretroviral therapy). Evidence suggests that HAART plays an important role in controlling the occurrence of oral candidosis. The effect of HAART on reducing the incidence of oral lesions, other than oral candidosis, does not appear as significant, possibly as a result of low lesion prevalence in industrialized countries. In contrast to other oral manifestations of HIV, an increased prevalence of oral warts in patients on HAART has been reported from the USA and the UK. HIV-related salivary gland disease may show a trend of rising prevalence in the USA and Europe. The re-emergence of HIV-related oral disease may be indicative of failing therapy. A range of orofacial iatrogenic consequences of HAART has been reported, and it is often difficult to distinguish between true HIV-related oral disease manifestations and the adverse effects of HAART. A possible association between an increased risk of oral squamous cell carcinoma and HIV infection has been suggested by at least three epidemiological studies, with reference to the lip and tongue. These substantial and intensive research efforts directed toward enhancing knowledge regarding the orofacial consequences of HIV infection in the industrialized nations require dissemination in the wider health care environment.
Collapse
Affiliation(s)
- T A Hodgson
- Unit of Oral Medicine, UCL Eastman Dental Institute and UCLHT Eastman Dental Hospital, 256 Gray's Inn Road, London, WC1X 8LD, UK.
| | | | | |
Collapse
|
11
|
Abstract
Fungal pathogens can lead to many of the complications seen in advanced HIV disease and are commonly identified in HIV-infected populations with decreased immune function. Common fungal organisms affecting individuals with AIDS include Cryptococcus neoformans, various Candida species, and Histoplasma capsulatum. While infection with these organisms can be fatal, appropriate identification and management of the condition can result in reduced mortality and the opportunity for effectivemanagement of HIV disease with highly active antiretroviral therapy. This article describes the clinical presentation and treatment of 3 fungal infections common in the immunocompromised individual with AIDS. Current antifungal therapy for themanagement of these infections is discussed. In addition, the role of newer antifungal agents in the setting of these conditions is reviewed.
Collapse
Affiliation(s)
- Melody L. Duffalo
- Penn Community Infectious Diseases, Penn Presbyterian Medical Center, 51 North 39th Street, Suite W241, Philadelphia, PA 19104
| |
Collapse
|
12
|
Menezes RDP, Borges AS, Araujo LBD, Pedroso RDS, Röder DVDDB. RELATED FACTORS FOR COLONIZATION BY Candida SPECIES IN THE ORAL CAVITY OF HIV-INFECTED INDIVIDUALS. Rev Inst Med Trop Sao Paulo 2016; 57:413-9. [PMID: 26603229 PMCID: PMC4660451 DOI: 10.1590/s0036-46652015000500008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/03/2015] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED The colonization of the oral cavity is a prerequisite to the development of oropharyngeal candidiasis. AIMS The aims of this study were: to evaluate colonization and quantify Candida spp. in the oral cavity; to determine the predisposing factors for colonization; and to correlate the levels of CD4+ cells and viral load with the yeast count of colony forming units per milliliter (CFU/mL) in HIV-positive individuals treated at a University Hospital. Saliva samples were collected from 147 HIV patients and were plated on Sabouraud Dextrose Agar (SDA) and chromogenic agar, and incubated at 30 ºC for 72 h. Colonies with similar morphology in both media were counted and the result expressed in CFU/mL. RESULTS Of the 147 HIV patients, 89 had positive cultures for Candida spp., with a total of 111 isolates, of which C. albicans was the most frequent species (67.6%), and the mean of colonies counted was 8.8 × 10³ CFU/mL. The main predisposing factors for oral colonization by Candida spp. were the use of antibiotics and oral prostheses. The use of reverse transcriptase inhibitors appears to have a greater protective effect for colonization. A low CD4+ T lymphocyte count is associated with a higher density of yeast in the saliva of HIV patients.
Collapse
|
13
|
Rao KVSE, Chitturi RT, Kattappagari KK, Kantheti LPC, Poosarla C, Baddam VRR. Impact of highly active antiretroviral therapy on oral manifestations of patients with human immunodeficiency virus/acquired immuno deficiency syndrome in South India. Indian J Sex Transm Dis AIDS 2015; 36:35-9. [PMID: 26392652 DOI: 10.4103/0253-7184.156703] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection remains a global health problem, although the development of highly active antiretroviral therapy (HAART) has significantly modified the course of HIV disease into a manageable disease with improved quality-of-life mainly in the developed countries. Very few studies are available regarding effect of HAART on oral lesions in developing countries like India. AIMS AND OBJECTIVES The aim was to document and compare oral lesions in HIV-seropositive patients before and after HAART. MATERIALS AND METHODS Oral manifestations were recorded in 320 HIV seropositive patients attending to the Voluntary Counseling and Confidential Testing Centre at the Government General Hospital, Guntur, before and after treating with HAART and the results were statistically analyzed using Student's t-test and Chi-square test. RESULTS Oral Candidiasis was significantly reduced in patients under HAART after 3 months. Furthermore, there was decreased incidence of periodontal diseases, but increased hyperpigmentation in patients undergoing HAART. CONCLUSION The oral manifestations of HIV infection have changed due to the advent of HAART. Many opportunistic infections have resolved as a result of an improved immune system. Though the risk of hyperpigmentation in those with HAART has increased the prevalence of oral candidiasis and periodontal diseases were less in patients who had access to HAART.
Collapse
Affiliation(s)
- K V S Eswara Rao
- Department of Oral Pathology, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India
| | - Ravi Teja Chitturi
- Department of Oral Pathology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | | | | | - Chandrasekhar Poosarla
- Department of Oral Pathology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | | |
Collapse
|
14
|
Shiboski CH, Chen H, Secours R, Lee A, Webster-Cyriaque J, Ghannoum M, Evans S, Bernard D, Reznik D, Dittmer DP, Hosey L, Sévère P, Aberg JA. High Accuracy of Common HIV-Related Oral Disease Diagnoses by Non-Oral Health Specialists in the AIDS Clinical Trial Group. PLoS One 2015; 10:e0131001. [PMID: 26148192 PMCID: PMC4492974 DOI: 10.1371/journal.pone.0131001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 05/27/2015] [Indexed: 11/20/2022] Open
Abstract
Objective Many studies include oral HIV-related endpoints that may be diagnosed by non-oral-health specialists (non-OHS) like nurses or physicians. Our objective was to assess the accuracy of clinical diagnoses of HIV-related oral lesions made by non-OHS compared to diagnoses made by OHS. Methods A5254, a cross-sectional study conducted by the Oral HIV/AIDS Research Alliance within the AIDS Clinical Trial Group, enrolled HIV-1-infected adults participants from six clinical trial units (CTU) in the US (San Francisco, New York, Chapel Hill, Cleveland, Atlanta) and Haiti. CTU examiners (non-OHS) received standardized training on how to perform an oral examination and make clinical diagnoses of specific oral disease endpoints. Diagnoses by calibrated non-OHS were compared to those made by calibrated OHS, and sensitivity and specificity computed. Results Among 324 participants, the majority were black (73%), men (66%), and the median CD4+ cell count 138 cells/mm3. The overall frequency of oral mucosal disease diagnosed by OHS was 43% in US sites, and 90% in Haiti. Oral candidiasis (OC) was detected in 153 (47%) by OHS, with erythematous candidiasis (EC) the most common type (39%) followed by pseudomembranous candidiasis (PC; 26%). The highest prevalence of OC (79%) was among participants in Haiti, and among those with CD4+ cell count ≤ 200 cells/mm3 and HIV-1 RNA > 1000 copies/mL (71%). The sensitivity and specificity of OC diagnoses by non-OHS were 90% and 92% (for EC: 81% and 94%; PC: 82% and 95%). Sensitivity and specificity were also high for KS (87% and 94%, respectively), but sensitivity was < 60% for HL and oral warts in all sites combined. The Candida culture confirmation of OC clinical diagnoses (as defined by ≥ 1 colony forming unit per mL of oral/throat rinse) was ≥ 93% for both PC and EC. Conclusion Trained non-OHS showed high accuracy of clinical diagnoses of OC in comparison with OHS, suggesting their usefulness in studies in resource-poor settings, but detection of less common lesions may require OHS.
Collapse
Affiliation(s)
- Caroline H. Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Huichao Chen
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Cambridge, Massachusetts, United States of America
| | | | - Anthony Lee
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Cambridge, Massachusetts, United States of America
| | - Jennifer Webster-Cyriaque
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Microbiology and Immunology, and Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Mahmoud Ghannoum
- Center for Medical Mycology, Department of Dermatology, Case Medical Center and Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Scott Evans
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Cambridge, Massachusetts, United States of America
| | | | - David Reznik
- Grady Health System, Atlanta Georgia, United States of America
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Dirk P. Dittmer
- Department of Microbiology and Immunology, and Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lara Hosey
- Social and Scientific Systems, Inc., Silver Spring, Maryland, United States of America
| | | | - Judith A. Aberg
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Medicine, New York University School of Medicine, New York, New York, United States of America
| | | |
Collapse
|
15
|
Ho MW, Yang YL, Lin CC, Chi CY, Chen HT, Lin PC, Hsieh LY, Chou CH, Chu WL, Wu CP, Lauderdale TL, Lo HJ. Yeast oropharyngeal colonization in human immunodeficiency virus-infected patients in central taiwan. Mycopathologia 2014; 177:309-17. [PMID: 24804977 DOI: 10.1007/s11046-014-9753-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
Abstract
A prospective, cross-sectional study was conducted at a medical center in central Taiwan to understand the prevalence, associated factors, and microbiologic features for oropharyngeal yeast colonization in human immunodeficiency virus-infected outpatients. Oral yeast colonization was detected in 127 (45 %) patients, including 21 (16.5 %) colonized by more than one species. Of the 154 isolates, Candida albicans was the most common species (114, 74 %), followed by Candida dubliniensis (10, 6.5 %), Candida glabrata (10, 6.5 %), Candida tropicalis (7, 4.5 %), and 13 others. We found that receiving antituberculous drug (p = 0.046) or atazanavir (p = 0.045) was two predictors for patients colonized by non-C. albicans species (p = 0.005) and risking mixed yeast colonization (p = 0.009). Even though our data showed that clinical antifungal drugs remained effective in vitro against the colonizing yeasts, the increased mixed yeast colonization indicates a potential issue for controlling mixed infections in hospital settings.
Collapse
Affiliation(s)
- Mao-Wang Ho
- Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
La candidiasis bucal como marcador clínico de falla a la terapia antirretroviral altamente efectiva en pacientes infectados con VIH/sida. INFECTIO 2014. [DOI: 10.1016/j.infect.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
17
|
Shiboski CH, Shiboski SC. Smoking is an independent risk factor for the development of oral candidiasis (OC) in HIV-1 infected persons. J Evid Based Dent Pract 2013; 13:180-2. [PMID: 24237746 DOI: 10.1016/j.jebdp.2013.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Caroline H Shiboski
- Professor, Department of Orofacial Sciences, University of California San Francisco, 513 Parnassus, Suite S612, San Francisco, CA 94143-0422, USA, Tel.: +1 415 476 5976.
| | | |
Collapse
|
18
|
Kathwate GH, Karuppayil SM. Antifungal properties of the anti-hypertensive drug: Aliskiren. Arch Oral Biol 2013; 58:1109-15. [DOI: 10.1016/j.archoralbio.2013.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/31/2013] [Accepted: 02/09/2013] [Indexed: 10/26/2022]
|
19
|
Demiraslan H, Alabay S, Kilic AU, Borlu M, Doganay M. Cutaneous candidiasis caused by Candida glabrata in a HIV/AIDS patient. Int J STD AIDS 2013; 24:753-5. [PMID: 23970580 DOI: 10.1177/0956462413479897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cutaneous Candida infections may occur in patients with HIV/AIDS, cancer, receiving chemotherapy and solid organ transplantation. A 32-year-old woman was admitted to the department suffering from pruritic and erythematous plaque on left side of her face for the past two months. The patient was HIV positive, diagnosed five years previously, and had been on antiretroviral therapy (tenofovir/emtricitabine and lopinavir/ritonavir) for a year. She was not compliant with the medication. Elevated HIV RNA load and decreased CD4+ lymphocyte count were observed. Fungal elements were detected from the skin scraping sample taken from the facial plaque. Fluconazole-sensitive Candida glabrata was isolated from this sample. Topical clotrimazole ointment and systemic fluconazole 400 mg/day were used. After systemic fluconazole therapy was continued for two months, the plaque was cured. C. glabrata rarely causes cutaneous infection without involving the mucous membranes. Presentation of cutaneous fungal infections in HIV patients with decreased CD4+ T lymphocyte counts can be atypical and require extensive antifungal treatment.
Collapse
Affiliation(s)
- Hayati Demiraslan
- Department of Infectious Diseases, Erciyes University, Kayseri, Turkey
| | | | | | | | | |
Collapse
|
20
|
Evans D, Maskew M, Sanne I. Increased risk of mortality and loss to follow-up among HIV-positive patients with oropharyngeal candidiasis and malnutrition before antiretroviral therapy initiation: a retrospective analysis from a large urban cohort in Johannesburg, South Africa. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 113:362-72. [PMID: 22669142 DOI: 10.1016/j.oooo.2011.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 09/02/2011] [Accepted: 09/07/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated the effect of oropharyngeal candidiasis (OC) and body mass index (BMI) before antiretroviral therapy (ART) initiation on treatment outcomes of human immunodeficiency virus (HIV)-positive patients. STUDY DESIGN Treatment outcomes included failure to increase CD4 count by ≥50 or ≥100 cells/μL or failure to suppress viral load (<400 copies/mL) at 6 or 12 months in addition to loss to follow-up (LTFU) and mortality by 12 months. Risk and hazard ratios (HRs) were estimated with the use of log-binomial regression and Cox proportional hazards models, respectively. RESULTS Baseline CD4 <100 cells/μL, low BMI (<18.5 kg/m(2)), low hemoglobin, and elevated aspartate transaminase were associated with OC at ART initiation. Patients with low BMI with and without, respectively, OC were at risk of mortality (HR 2.42, 95% CI 1.88-3.12; HR 1.87, 95% CI 1.54-2.28) and LTFU (HR 1.36, 95% CI 1.02-1.82; HR 1.55, 95% CI 1.30-1.85). CONCLUSIONS Low BMI (with/without OC) at ART initiation was associated with poor treatment outcomes. Conversely, normal BMI with OC was associated with adequate CD4 response and reduced LTFU compared with without OC.
Collapse
Affiliation(s)
- Denise Evans
- Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | | | | |
Collapse
|
21
|
Mehra T, Köberle M, Braunsdorf C, Mailänder-Sanchez D, Borelli C, Schaller M. Alternative approaches to antifungal therapies. Exp Dermatol 2013; 21:778-82. [PMID: 23078400 DOI: 10.1111/exd.12004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The expansive use of immunosuppressive medications in fields such as transplantational medicine and oncology, the higher frequency of invasive procedures in an ageing population and the HIV/AIDS pandemic have increased the frequency of systemic fungal infections. At the same time, increased resistance of pathogenic fungi to classical antifungal agents has led to sustained research efforts targeting alternative antifungal strategies. In this review, we focus on two promising approaches: cationic peptides and the targeting of fungal virulence factors. Cationic peptides are small, predominantly positively charged protein fragments that exert direct and indirect antifungal activities, one mechanism of action being the permeabilization of the fungal membrane. They include lysozyme, defensins and cathelicidins as well as novel synthetic peptides. Among fungal virulence factors, the targeting of candidal secreted aspartic proteinases seems to be a particularly promising approach.
Collapse
Affiliation(s)
- Tarun Mehra
- Department of Dermatology, Eberhard-Karls-University, Tübingen, Germany
| | | | | | | | | | | |
Collapse
|
22
|
Li X, Lei L, Tan D, Jiang L, Zeng X, Dan H, Liao G, Chen Q. Oropharyngeal Candida colonization in human immunodeficiency virus infected patients. APMIS 2012; 121:375-402. [PMID: 23030258 DOI: 10.1111/apm.12006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 08/26/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Xiaoxu Li
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Lei Lei
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Dan Tan
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Lu Jiang
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Ga Liao
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| |
Collapse
|
23
|
Vazquez JA, Sobel JD. Miconazole mucoadhesive tablets: a novel delivery system. Clin Infect Dis 2012; 54:1480-4. [PMID: 22495075 DOI: 10.1093/cid/cis205] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Oropharyngeal candidiasis (OPC) is among the most common opportunistic infections observed in persons infected with human immunodeficiency virus. A once-daily miconazole 50 mg mucoadhesive buccal tablet (MBT) is a novel delivery system with potent in vitro activity against many Candida species, including some that may be resistant to other azoles. MBT, although more expensive, offers an effective, safe, and well-tolerated topical treatment option for OPC that is administered as a convenient once-daily dose.
Collapse
Affiliation(s)
- José A Vazquez
- Department of Medicine, Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI 48201, USA.
| | | |
Collapse
|
24
|
Abstract
Oropharyngeal candidiasis is a frequent cause of morbidity in patients with defects in cell-mediated immunity or saliva production. Animal models of this infection are important for studying disease pathogenesis and evaluating vaccines and antifungal therapies. Here we describe a simple mouse model of oropharyngeal candidiasis. Mice are rendered susceptible to oral infection by injection with cortisone acetate and then inoculated by placing a swab saturated with Candida albicans sublingually. This process results in a reproducible level of infection, the histopathology of which mimics that of pseudomembranous oropharyngeal candidiasis in humans. By using this model, data are obtained after 5-9 d of work.
Collapse
Affiliation(s)
- Norma V Solis
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | | |
Collapse
|
25
|
Demarchi IG, Cardozo DM, Aristides SMA, Moliterno RA, Silveira TGV, Cardoso RF, Bertolini DA, Svidzinski TIE, Teixeira JJV, Lonardoni MVC. Activity of antiretroviral drugs in human infections by opportunistic agents. BRAZ J PHARM SCI 2012. [DOI: 10.1590/s1984-82502012000100019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Highly active antiretroviral therapy (HAART) is used in patients infected with HIV. This treatment has been shown to significantly decrease opportunist infections such as those caused by viruses, fungi and particularly, protozoa. The use of HAART in HIV-positive persons is associated with immune reconstitution as well as decreased prevalence of oral candidiasis and candidal carriage. Antiretroviral therapy benefits patients who are co-infected by the human immunodeficiency virus (HIV), human herpes virus 8 (HHV-8), Epstein-Barr virus, hepatitis B virus (HBV), parvovirus B19 and cytomegalovirus (CMV). HAART has also led to a significant reduction in the incidence, and the modification of characteristics, of bacteremia by etiological agents such as Staphylococcus aureus, coagulase negative staphylococcus, non-typhoid species of Salmonella, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Mycobacterium tuberculosis. HAART can modify the natural history of cryptosporidiosis and microsporidiosis, and restore mucosal immunity, leading to the eradication of Cryptosporidium parvum. A similar restoration of immune response occurs in infections by Toxoplasma gondii. The decline in the incidence of visceral leishmaniasis/HIV co-infection can be observed after the introduction of protease inhibitor therapy. Current findings are highly relevant for clinical medicine and may serve to reduce the number of prescribed drugs thereby improving the quality of life of patients with opportunistic diseases.
Collapse
|
26
|
Wu CJ, Lee HC, Yang YL, Chang CM, Chen HT, Lin CC, Lee NY, Chu WL, Hsieh LY, Wang YL, Lauderale TL, Tseng FC, Ko NY, Ko WC, Lo HJ. Oropharyngeal yeast colonization in HIV-infected outpatients in southern Taiwan: CD4 count, efavirenz therapy and intravenous drug use matter. Clin Microbiol Infect 2011; 18:485-90. [PMID: 21939471 DOI: 10.1111/j.1469-0691.2011.03655.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To understand the status of oropharyngeal yeast colonization in human immunodeficiency virus (HIV) -infected outpatients in the era of highly active antiretroviral therapy (HAART), we conducted a prospective, cross-sectional study from October 2009 to January 2010 at a medical centre in southern Taiwan. Fungal cultures of the oropharyngeal swabs were performed on 327 enrolled patients. At enrolment, 258 (79%) patients had been receiving HAART, and 42 (12.8%), 73 (22.3%) and 212 (64.8%) patients had CD4 cell counts ≤200, 201-350, and >350 cells/mm(3) , respectively. Oral yeast colonization was detected in 193 (59%) patients, among whom 157 (81.3%), 25 (13.0%), and 11 (5.7%) were colonized by a single, two and more than two species, respectively. Multivariate analysis showed that receipt of efavirenz-containing regiments and CD4 cell counts >200 cells/mm(3) were associated with lower risks of oral yeast colonization, while intravenous drug users were at a higher risk. Among the 241 isolates recovered, Candida albicans accounted for 69.7%, followed by C. dubliniensis (9.5%), C. glabrata (8.3%), C. tropicalis (3.3%), C. intermedia (2.1%), C. parapsilosis (1.7%), and 11 other species (5.4%). Overall, 230 (95.4%), 236 (97.9%) and 240 (99.6%) isolates were susceptible to fluconazole, voriconazole and amphotericin B, respectively. In conclusion, colonization by C. dubliniensis has emerged in recent years. In addition to a CD4 cell count ≤200 cells/mm(3) , which is a known risk factor for oropharyngeal yeast colonization in HIV-infected patients that was identified in our previous studies, two risk factors, non-receipt of efavirenz-based combinations and intravenous drug use, were first identified in the present study. Fluconazole remained effective in vitro against the yeasts colonizing the oropharynx in this population.
Collapse
Affiliation(s)
- C-J Wu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Shiboski CH, Webster-Cyriaque JY, Ghannoum M, Greenspan JS, Dittmer D. Overview of the oral HIV/AIDS Research Alliance Program. Adv Dent Res 2011; 23:28-33. [PMID: 21441477 DOI: 10.1177/0022034511399084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Oral HIV/AIDS Research Alliance is part of the AIDS Clinical Trials Group, the largest HIV clinical trial organization in the world, and it is funded by the National Institute of Dental and Craniofacial Research, in collaboration with the National Institute of Allergy and Infectious Diseases. The alliance's main objective is to investigate the oral complications associated with HIV/AIDS as the epidemic is evolving-in particular, the effects of potent antiretrovirals on the development of oral mucosal lesions and associated fungal and viral pathogens. Furthermore, oral fluids are being explored for their potential monitoring and diagnostic role with respect to HIV disease and coinfections. This article presents an overview of the alliance, its scientific agenda, and an outline of the novel interventional and noninterventional clinical studies ongoing and developing within the AIDS Clinical Trials Group infrastructure in the United States and internationally.
Collapse
Affiliation(s)
- C H Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California-San Francisco, San Francisco, California, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Pienaar ED, Young T, Holmes H. Interventions for the prevention and management of oropharyngeal candidiasis associated with HIV infection in adults and children. Cochrane Database Syst Rev 2010:CD003940. [PMID: 21069679 PMCID: PMC7156835 DOI: 10.1002/14651858.cd003940.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Oral candidiasis (OC) associated with human immunodeficiency virus (HIV) infection occurs commonly and recurs frequently, often presenting as an initial manifestation of the disease. Left untreated, these lesions contribute considerably to the morbidity associated with HIV infection. Interventions aimed at preventing and treating HIV-associated oral candidal lesions form an integral component of maintaining the quality of life for affected individuals. OBJECTIVES To determine the effects of any intervention in preventing or treating OC in children and adults with HIV infection. SEARCH STRATEGY The search strategy was based on that of the Cochrane HIV/AIDS Review Group. The following electronic databases were searched for randomised controlled trials for the years 1982 to 2005: Medline, AIDSearch, EMBASE and CINAHL. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, and the Cochrane Central Register of Controlled Trials (CENTRAL) were also searched through May 2005. The abstracts of relevant conferences, including the International Conferences on AIDS and the Conference on Retroviruses and Opportunistic Infections, as indexed by AIDSLINE, were also reviewed. The strategy was iterative, in that references of included studies were searched for additional references. All languages were included.The updated database search was done for the period 2005 up to 2009. The following databases were searched: Medline, EMBASE, the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library. AIDSearch was not searched for the updated search as it ceased publication during 2008. SELECTION CRITERIA Randomised controlled trials (RCTs) of palliative, preventative or curative therapy were considered, irrespective of whether the control group received a placebo. Participants were HIV positive adults and children. DATA COLLECTION AND ANALYSIS Two authors independently assessed the methodological quality of the trials and extracted data. Study authors were contacted for additional data where necessary. MAIN RESULTS For the first publication of the review in 2006, forty studies were retrieved. Twenty eight trials (n=3225) met inclusion criteria. During the update search for the review a, further six studies were identified. Of these, five met the inclusion criteria and were included in the review. The review now includes 33 studies (n=3445): 22 assessing treatment and 11 assessing prevention of oropharyngeal candidiasis. Six studies were done in developing countries, 16 in the United States of America and the remainder in Europe.Treatment Treatment was assessed in the majority of trials looking at both clinical and mycological cures. In the majority of comparisons there was only one trial. Compared to nystatin, fluconazole favoured clinical cure in adults (1 RCT; n=167; RR 1.69; 95% CI 1.27 to 2.23). There was no difference with regard to clinical cure between fluconazole compared to ketoconazole (2 RCTs; n=83; RR 1.27; 95% CI 0.97 to 1.66), itraconazole (2 RCTs; n=434; RR 1.05; 95% CI 0.94 to 1.16), clotrimazole (2 RCTs; n=358; RR 1.14; 95% CI 0.92 to 1.42) or posaconazole (1 RCT; n=366; RR1.32; 95% CI 0.36 to 4.83). Two trials compared different dosages of fluconazole with no difference in clinical cure. When compared with clotrimazole, both fluconazole (2 RCTs; n=358; RR 1.47; 95% CI 1.16 to 1.87) and itraconazole (1 RCT; n=123; RR 2.20; 95% CI 1.43 to3.39) proved to be better for mycological cure. Both gentian violet (1 RCT; n=96; RR 5.28; 95% CI 1.23 to 22.55) and ketoconazole (1 RCT; n=92; RR 5.22; 95% CI 1.21 to 22.53) were superior to nystatin in bringing about clinical cure. A single trial compared gentian violet with lemon juice and lemon grass with no significant difference in clinical cure between the groups. Prevention Successful prevention was defined as the prevention of a relapse while receiving prophylaxis. Fluconazole was compared with placebo in five studies (5 RCTs; n=599; RR 0.61; 95% CI 0.5 to 0.74) and with no treatment in another (1 RCT; n=65; RR 0.16; 95% CI 0.08 to 0.34). In both instances the prevention of clinical episodes was favoured by fluconazole. Comparing continuous fluconazole treatment with intermittent treatment (2 RCTs; n=891; RR 0.65; 95% CI 0.23 to 1.83), there was no significant difference between the two treatment arms. Chlorhexidine was compared with normal saline in a single study with no significant difference between the treatment arms. AUTHORS' CONCLUSIONS Five new studies were added to the review, but their results do not alter the final conclusion of the review.Implications for practice Due to there being only one study in children, it is not possible to make recommendations for treatment or prevention of OC in children. Amongst adults, there were few studies per comparison. Due to insufficient evidence, no conclusion could be made about the effectiveness of clotrimazole, nystatin, amphotericin B, itraconazole or ketoconazole with regard to OC prophylaxis. In comparison to placebo, fluconazole is an effective preventative intervention. However, the potential for resistant Candida organisms to develop, as well as the cost of prophylaxis, might impact the feasibility of implementation. No studies were found comparing fluconazole with other interventions. The direction of findings suggests that ketoconazole, fluconazole, itraconazole and clotrimazole improved the treatment outcomes.Implications for research It is encouraging that low-cost alternatives are being tested, but more research needs to be on in this area and on interventions like gentian violet and other less expensive anti-fungal drugs to treat OC. More well-designed treatment trials with larger samples are needed to allow for sufficient power to detect differences in not only clinical, but also mycological, response and relapse rates. There is also a strong need for more research to be done on the treatment and prevention of OC in children as it is reported that OC is the most frequent fungal infection in children and adolescents who are HIV positive. More research on the effectiveness of less expensive interventions also needs to be done in resource-poor settings. Currently few trials report outcomes related to quality of life, nutrition, or survival. Future researchers should consider measuring these when planning trials. Development of resistance remains under-studied and more work must be done in this area. It is recommended that trials be more standardised and conform more closely to CONSORT.
Collapse
Affiliation(s)
- Elizabeth D Pienaar
- South African Cochrane Centre, Medical Research Council, PO Box 19070, Tygerberg, South Africa, 7505
| | | | | |
Collapse
|
29
|
Mulu A, Diro E, Tekleselassie H, Belyhun Y, Anagaw B, Alemayehu M, Gelaw A, Biadglegne F, Desalegn K, Yifiru S, Tiruneh M, Kassu A, Nishikawa T, Isogai E. Effect of Ethiopian multiflora honey on fluconazole-resistant Candida species isolated from the oral cavity of AIDS patients. Int J STD AIDS 2010; 21:741-5. [DOI: 10.1258/ijsa.2010.010140] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to determine the antifungal effect of Ethiopian multiflora honey against Candida species isolated from the oral cavity of AIDS patients. Oral rinses were obtained from 13 AIDS patients and cultured on CHROMagar plates at 37°C for 48 hours. Candida species were identified by microbiological and molecular techniques. The antifungal effect of the honey sample on Candida was investigated by an agar dilution technique. Susceptibility of the Candida species to fluconazole was tested following a semi-modified microdilution method. Growth of both fluconazole-susceptible and -resistant Candida species was inhibited with a minimum fungicidal concentration (MFC) of 35–40% (v/v) honey. The MFC of different Candida species was not significantly different ( P > 0.05). From the total of 25 Candida isolates tested for susceptibility, 11 (44%), eight (32%) and six (24%) of the isolates were sensitive (minimum inhibitory concentrations [MICs] < 8 µg/mL), susceptible (dose-dependent: MICs 16–32 µg/mL) and resistant (MICs > 64 µg/mL) to fluconazole, respectively. Ethiopian multiflora honey has antifungal activity against fluconazole-resistant Candida species isolated from the oral cavity of AIDS patients. This supports the existing folkloric practice of using honey to treat oral lesions. Nevertheless, identification of the bioactive agents in honey, their clinical evaluation and pharmacological standardization are crucial.
Collapse
Affiliation(s)
- A Mulu
- Department of Microbiology and Parasitology
| | - E Diro
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar
| | - H Tekleselassie
- Department of Surgery, Facility of Medicine, Addis Ababa University, Addis Ababa
| | - Y Belyhun
- Department of Microbiology and Parasitology
| | - B Anagaw
- Department of Microbiology and Parasitology
| | | | - A Gelaw
- Department of Microbiology and Parasitology
| | | | | | - S Yifiru
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - M Tiruneh
- Department of Microbiology and Parasitology
| | - A Kassu
- Department of Microbiology and Parasitology
| | - T Nishikawa
- Hokkaido University of Education, Division of Medicine and Nursing, Sapporo
| | - E Isogai
- Department of Disease Control and Molecular Epidemiology, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan
| |
Collapse
|
30
|
Genetic variation of innate immune genes in HIV-infected african patients with or without oropharyngeal candidiasis. J Acquir Immune Defic Syndr 2010; 55:87-94. [PMID: 20577092 DOI: 10.1097/qai.0b013e3181e53c64] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The occurrence of oropharyngeal candidiasis (OPC) in combination with HIV disease progression is a very common phenomenon. However, not all HIV-infected patients develop OPC, even when they progress to low CD4 T-cell counts. Because T-cell immunity is defective in AIDS, the innate defence mechanisms are likely to have a central role in antifungal immunity in these patients. We investigated whether genetic variations in the innate immune genes DECTIN-1, TLR2, TLR4, TIRAP, and CASPASE-12 are associated with the presence of OPC in HIV-infected subjects from East Africa. METHODS A total of 225 HIV patients were genotyped for several single nucleotide polymorphisms (SNPs), and this was correlated with the occurrence of OPC in these patients. In addition, primary immune cells obtained from individuals with different genotypes were stimulated with Candida albicans, and cytokine production was measured. RESULTS The analysis revealed that no significant differences in the polymorphism frequencies could be observed, although a tendency toward a protective effect on OPC of the DECTIN-1 I223S SNP was apparent. Furthermore, interferon gamma production capacity was markedly lower in cells bearing the DECTIN-1 SNP I223S. It could also be demonstrated that the 223S mutated form of the DECTIN-1 gene exhibits a lower capacity to bind zymosan. CONCLUSIONS These data demonstrate that common polymorphisms of TLR2, TLR4, TIRAP, and CASPASE-12 do not influence susceptibility to OPC in HIV-infected patients in East Africa but suggest an immunomodulatory effect of the I223S SNP on dectin-1 function and possibly the susceptibility to OPC in HIV patients.
Collapse
|
31
|
Vazquez JA, Patton LL, Epstein JB, Ramlachan P, Mitha I, Noveljic Z, Fourie J, Conway B, Lalla RV, Barasch A, Attali P. Randomized, Comparative, Double-Blind, Double-Dummy, Multicenter Trial of Miconazole Buccal Tablet and Clotrimazole Troches for the Treatment of Oropharyngeal Candidiasis: Study of Miconazole Lauriad ®Efficacy and Safety (SMiLES). HIV CLINICAL TRIALS 2010; 11:186-196. [DOI: 10.1310/hct1104-186] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
32
|
Kolhatkar S, Haque SA, Winkler JR, Bhola M. Root coverage in an HIV-positive individual: combined use of a lateral sliding flap and resin-modified glass ionomer for the management of an isolated severe recession defect. J Periodontol 2010; 81:632-40. [PMID: 20367106 DOI: 10.1902/jop.2009.090616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Gingival recession is a frequent clinical finding in the general population. Exposed root surfaces are more likely to develop root sensitivity and root caries and pose esthetic concerns for the patient. Most root coverage procedures have been described on non-restored root surfaces. Limited data are available that describe root coverage procedures on restored root surfaces. To our knowledge, this is the first case report in which a severe recession defect and its associated carious lesion were managed using the combination of a lateral sliding flap and a resin-modified glass ionomer restoration in an HIV-positive individual. METHODS A 53-year-old male patient with a 25-year history of HIV infection presented for comprehensive care. The facial surface of tooth #22 had a fractured composite restoration, recurrent decay, and a Miller Class III recession defect. The lesion was restored with resin-modified glass ionomer and root coverage was obtained by a lateral sliding flap mobilized from the adjacent edentulous ridge. After 8 weeks, surgical access was used to correct a previously undetected void in the restoration. RESULTS Uneventful healing was observed at the 1-, 4-, 8-, 10-, 12-, and 24-week postoperative visits. Root coverage of 5 mm along with a 2-mm band of keratinized tissue was obtained at 24 weeks. The gingiva displayed no signs of inflammation and was tightly adapted to the root surface with minimal probing depths circumferentially. CONCLUSION Successful root coverage was obtained on a resin-modified glass ionomer-restored surface in an HIV-positive individual.
Collapse
Affiliation(s)
- Shilpa Kolhatkar
- Department of Periodontology and Dental Hygiene, School of Dentistry, University of Detroit Mercy, Detroit, MI, USA.
| | | | | | | |
Collapse
|
33
|
Ramos-e-Silva M, Lima CMO, Schechtman RC, Trope BM, Carneiro S. Superficial mycoses in immunodepressed patients (AIDS). Clin Dermatol 2010; 28:217-25. [DOI: 10.1016/j.clindermatol.2009.12.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
34
|
Danaher RJ, Wang C, Roland AT, Kaetzel CS, Greenberg RN, Miller CS. HIV protease inhibitors block oral epithelial cell DNA synthesis. Arch Oral Biol 2009; 55:95-100. [PMID: 20035926 DOI: 10.1016/j.archoralbio.2009.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 11/13/2009] [Accepted: 12/01/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Anti-retroviral therapy regimens that include HIV protease inhibitors (PIs) are associated with diverse adverse effects including increased prevalence of oral warts, oral sensorial deficits and gastrointestinal toxicities suggesting that PIs may perturb epithelial cell biology. To test the hypothesis that PIs could affect specific biological processes of oral epithelium, the effects of these agents were evaluated in several oral epithelial cell-lines. DESIGN Primary and immortalized oral keratinocytes and squamous carcinoma cells of oropharyngeal origin were cultured in the presence of pharmacologically relevant concentrations of PIs. Their affects on cell viability, cytotoxicity and DNA synthesis were assessed by enzymatic assays and incorporation of 5-bromo-2'-deoxyuridine (BrdU) into DNA. RESULTS Viability of primary and immortalized oral keratinocytes as well as squamous carcinoma cells of oropharyngeal origin was significantly reduced by select PIs at concentrations found in plasma. Of the seven PIs evaluated, nelfinavir was the most potent with a mean 50% inhibitory concentration [IC(50)] of 4.1 microM. Lopinavir and saquinavir also reduced epithelial cell viability (IC(50) of 10-20 microM). Atazanavir and ritonovir caused minor reductions in viability, while amprenavir and indinavir were not significant inhibitors. The reduced cell viability, as shown by BrdU incorporation assays, was due to inhibition of DNA synthesis rather than cell death due to cytotoxicity. CONCLUSION Select PIs retard oral epithelial cell proliferation in a drug and dose-dependent manner by blocking DNA synthesis. This could account for some of their adverse effects on oral health.
Collapse
Affiliation(s)
- Robert J Danaher
- Department of Oral Health Practice, University of Kentucky, Lexington, KY 40536-0297, USA
| | | | | | | | | | | |
Collapse
|
35
|
Shiboski CH, Patton LL, Webster-Cyriaque JY, Greenspan D, Traboulsi RS, Ghannoum M, Jurevic R, Phelan JA, Reznik D, Greenspan JS. The Oral HIV/AIDS Research Alliance: updated case definitions of oral disease endpoints. J Oral Pathol Med 2009; 38:481-8. [PMID: 19594839 PMCID: PMC10431909 DOI: 10.1111/j.1600-0714.2009.00749.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The Oral HIV/AIDS Research Alliance (OHARA) is part of the AIDS Clinical Trials Group (ACTG), the largest HIV clinical trials organization in the world. Its main objective is to investigate oral complications associated with HIV/AIDS as the epidemic is evolving, in particular, the effects of antiretrovirals on oral mucosal lesion development and associated fungal and viral pathogens. The OHARA infrastructure comprises: the Epidemiologic Research Unit (at the University of California San Francisco), the Medical Mycology Unit (at Case Western Reserve University) and the Virology/Specimen Banking Unit (at the University of North Carolina). The team includes dentists, physicians, virologists, mycologists, immunologists, epidemiologists and statisticians. Observational studies and clinical trials are being implemented at ACTG-affiliated sites in the US and resource-poor countries. Many studies have shared end-points, which include oral diseases known to be associated with HIV/AIDS measured by trained and calibrated ACTG study nurses. In preparation for future protocols, we have updated existing diagnostic criteria of the oral manifestations of HIV published in 1992 and 1993. The proposed case definitions are designed to be used in large-scale epidemiologic studies and clinical trials, in both US and resource-poor settings, where diagnoses may be made by non-dental healthcare providers. The objective of this article is to present updated case definitions for HIV-related oral diseases that will be used to measure standardized clinical end-points in OHARA studies, and that can be used by any investigator outside of OHARA/ACTG conducting clinical research that pertains to these end-points.
Collapse
Affiliation(s)
- C H Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94143-0422, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Delgado A, de Jesus Pedro R, Aoki F, Resende M, Trabasso P, Colombo A, de Oliveira M, Mikami Y, Moretti M. Clinical and microbiological assessment of patients with a long-term diagnosis of human immunodeficiency virus infection and Candida oral colonization. Clin Microbiol Infect 2009; 15:364-71. [DOI: 10.1111/j.1469-0691.2009.02707.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
Miró JM. Prevención de las infecciones oportunistas en pacientes adultos y adolescentes infectados por el VIH en el año 2008. Enferm Infecc Microbiol Clin 2008; 26:437-64. [DOI: 10.1157/13125642] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
38
|
|
39
|
Oral candidiasis as a marker of HIV disease progression among Zimbabwean women. J Acquir Immune Defic Syndr 2008; 47:579-84. [PMID: 18176326 DOI: 10.1097/qai.0b013e318160a554] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To estimate oral disease prevalence among Zimbabwean women by HIV serostatus and CD4 cell count and to assess accuracy of oral disease diagnoses made by nurses as compared with an oral surgeon. METHODS Standardized oral mucosa examinations were performed by trained nurse-examiners and by an oral surgeon among women recruited in Harare, Zimbabwe. RESULTS A total of 461 women (320 HIV-infected, 141 uninfected) were seen by nurses and an oral surgeon within a 2-week period. Oral candidiasis (OC) was the most common lesion diagnosed in nearly one quarter of HIV-infected women, whereas hairy leukoplakia and Kaposi sarcoma were found in <3%. The prevalence of OC diagnosed by nurses or the surgeon was significantly higher among women with a CD4 count <200 cells/mm than in women with a CD4 count from 200 to 499 cells/mm3 or a CD4 count >499 cells/mm3. The sensitivity of nurse examinations compared with examinations by the oral surgeon among HIV-infected women for the diagnosis of OC was 73%, the specificity was 95%, and the kappa-statistic was 0.71. CONCLUSIONS OC was the most common lesion in HIV-infected women and was strongly associated with a low CD4 cell count. Interexaminer agreement was good for the diagnosis of OC among HIV-infected women. This study suggests that OC may play a role, in combination with other clinical indicators as a marker of disease progression in resource-poor settings.
Collapse
|
40
|
Miziara ID, Weber R. Oral lesions as predictors of highly active antiretroviral therapy failure in Brazilian HIV-infected children. J Oral Pathol Med 2008; 37:99-106. [PMID: 18197855 DOI: 10.1111/j.1600-0714.2007.00598.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Evaluate the accuracy of HIV-related oral lesions to predict immune and virologic failure on HIV-infected children in use of highly active antiretroviral therapy (HAART). STUDY DESIGN Data for this cross-sectional analysis come from a longitudinal study being conducted through the HIV-AIDS Outpatient Unit, ENT Division, Hospital das Clinicas, Sao Paulo University Medical School. The study began in January 1990 and is still ongoing. The cut-off point for analyses purposes was December 2004. Subjects were 471 HIV-infected consecutive children attending the outpatient unit during this period, who enrolled regardless of medical or immunological status. The children have undertaken oral cavity examination, serum CD4(+) T-lymphocyte count, and, 271 of them, viral load measurement. Sensitivity, specificity, positive predictive value, negative predictive value and relative risk were calculated. RESULTS Oral lesions had moderate sensitivity, high specificity and positive predictive value to predict immune failure. It had low sensitivity and positive predictive value, and high specificity to predict virologic failure. DISCUSSION AND CONCLUSIONS Oral manifestations of HIV can be important markers for immune suppression and for virologic failure, in Brazilian children undergoing HAART.
Collapse
Affiliation(s)
- Ivan Dieb Miziara
- ENT Discipline, Sao Paulo University Medical School - Group of Otorhinolaryngology and AIDS, Sao Paulo, Brazil.
| | | |
Collapse
|
41
|
Erköse G, Erturan Z. Oral Candida colonization of human immunodeficiency virus infected subjects in Turkey and its relation with viral load and CD4+T-lymphocyte count. Mycoses 2007; 50:485-90. [PMID: 17944711 DOI: 10.1111/j.1439-0507.2007.01393.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Gonca Erköse
- Department of Microbiology and Clinical Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | |
Collapse
|
42
|
Costa CR, Cohen AJ, Fernandes OFL, Miranda KC, Passos XS, Souza LKH, do Rosário Rodrigues Silva M. Asymptomatic oral carriage of Candida species in HIV-infected patients in the highly active antiretroviral therapy era. Rev Inst Med Trop Sao Paulo 2007; 48:257-61. [PMID: 17086312 DOI: 10.1590/s0036-46652006000500004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Accepted: 05/17/2006] [Indexed: 11/21/2022] Open
Abstract
Oropharyngeal candidiasis is the most common opportunistic fungal infection in individuals infected with human immunodeficiency virus. CD4+ lymphocytes count and the quantification of viral RNA in blood plasma have been found to be the main markers of HIV disease progression. The present study was conducted to evaluate Candida sp. diversity in the oral cavity of HIV-infected patients and to determine whether there was association of CD4+ cell count and viral load with asymptomatic oral Candida carriage. Out of 99 HIV-positive patients studied, 62 (62.6%) had positive culture for Candida (oral carriage) and 37 patients (37.4%) had Candida negative culture (no oral carriage). The etiologic agents most common were C. albicans and C. tropicalis. The range of CD4+ was 6-2305 cells/mm3 in colonized patients and 3-839 cells/mm3 for non-colonized patients, while the viral load was 60-90016 copies/mL for colonized patients and 75-110488 copies/mL for non colonized patients. The viral load was undetectable in 15 colonized patients and in 12 non colonized patients. Our results showed that there was no significant difference of the variables CD4+ cell count and viral load between oral candida carriage and no oral candida carriage patients.
Collapse
Affiliation(s)
- Carolina Rodrigues Costa
- Laboratório de Micologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, and Hospital de Doenças Tropicais de Goiás, Goiânia, GO, Brazil
| | | | | | | | | | | | | |
Collapse
|
43
|
Umadevi KMR, Ranganathan K, Pavithra S, Hemalatha R, Saraswathi TR, Kumarasamy N, Solomon S, Greenspan JS. Oral lesions among persons with HIV disease with and without highly active antiretroviral therapy in southern India. J Oral Pathol Med 2007; 36:136-41. [PMID: 17305634 DOI: 10.1111/j.1600-0714.2006.00505.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The advent of highly active antiretroviral therapy (HAART) has changed the scenario of human immunodeficiency virus (HIV) infection. HIV patients in India have now access to generic HAART and this is the first report describing oral lesions in patients on HAART from our country. METHODS Oral lesions were studied in HIV seropositive patients (n = 50 on HAART and n = 50 not on HAART) attending a tertiary HIV referral care centre in India and patients on HAART were followed up. RESULTS There was a difference in the occurrence of oral candidiasis (OC) between HAART and non-HAART participants (8%, 24%; P < 0.05). Pseudomembranous candidiasis was 4% and 18% in HAART and non-HAART groups respectively (P < 0.05). In patients with CD4 count <or=200, OC was 5.6% in the HAART group and 39.1% in the non-HAART group (P < 0.05). Among patients with CD4 count >200, pigmentation was 43.8% in the HAART group and 14.8% in the non-HAART group (P < 0.05). CONCLUSION The prevalence of OC in patients who had access to HAART was less when compared with those who did not have access to HAART.
Collapse
Affiliation(s)
- K M R Umadevi
- Ragas Dental College and Hospital, Uthandi, Chennai, India.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Pienaar ED, Young T, Holmes H. Interventions for the prevention and management of oropharyngeal candidiasis associated with HIV infection in adults and children. Cochrane Database Syst Rev 2006:CD003940. [PMID: 16856025 DOI: 10.1002/14651858.cd003940.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Oral candidiasis (OC) associated with human immunodeficiency virus (HIV) infection occurs commonly and recurs frequently, often presenting as an initial manifestation of the disease. Left untreated these lesions contribute considerably to the morbidity associated with HIV infection. Interventions aimed at preventing and treating HIV-associated oral candidal lesions form an integral component of maintaining the quality of life for affected individuals. OBJECTIVES To determine the effects of any intervention in preventing or treating OC in children and adults with HIV infection. SEARCH STRATEGY The search strategy was based on that of the HIV/AIDS Cochrane Review Group. The following electronic databases were searched for randomised controlled trials for the years 1982 to 2005: Medline; AIDSearch; EMBASE and CINAHL. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness and the Cochrane Central Register of Controlled Trials (CENTRAL) was also searched through May 2005. The abstracts of relevant conferences, including the International Conferences on AIDS and the Conference on Retroviruses and Opportunistic Infections, as indexed by AIDSLINE, were also reviewed. The strategy was iterative, in that references of included studies were searched for additional references. All languages were included. SELECTION CRITERIA Randomised controlled trials (RCTs) of palliative, preventative or curative therapy were considered, irrespective of whether the control group received a placebo. Participants were HIV positive adults. DATA COLLECTION AND ANALYSIS Two authors independently assessed the methodological quality of the trials and extracted data. Study authors were contacted for additional data where necessary. MAIN RESULTS Four trials were conducted in developing countries with eleven of the trials conducted in the United States of America. Twenty eight trials (n=3225) were included. Nineteen trials investigated treatment and nine trials the prevention of OC. One trial, comparing fluconazole and ketoconazole, investigated the treatment of OC in children. Eighteen of the included studies reported CD4 cell counts. None of the included studies investigated the effects of HAART or any other form of antiretroviral treatment on OC treatment or prevention.TreatmentTreatment was assessed in the majority of trials looking at both clinical and mycological cures. In the majority of comparisons there was only one trial. Compared to nystatin, fluconazole favoured clinical cure in adults(1 RCT; n=167; RR 1.69; 95% CI 1.27 to 2.23). There was no difference with regard to clinical cure between fluconazole compared to ketoconazole (2 RCTs; n=83; RR 1.27; 95% CI 0.97 to 1.66), itraconazole (2 RCTs; n=434; RR 1.05; 95% CI 0.94 to 1.16) or clotrimazole (2 RCTs; n=358; RR 1.14; 95% CI 0.92 to 1.42). When compared with clotrimazole, both fluconazole (2 RCTs; n=358; RR 1.47; 95% CI 1.16 to 1.87) and itraconazole (1 RCT; n=123; RR 2.20; 95% CI 1.43 to3.39) proved to be better for mycological cure. Both gentian violet (1 RCT; n=96; RR 5.28; 95% CI 1.23 to 22.55) and ketoconazole (1 RCT; n=92; RR 5.22; 95% CI 1.21 to 22.53) were superior to nystatin in bringing about clinical cure. PreventionSuccessful prevention was defined as the prevention of a relapse while receiving prophylaxis. Fluconazole was compared with placebo in one trial (5 RCTs; n=599; RR 0.61; 95% CI 0.5 to 0.74) and with no treatment in another (1 RCT; n=65; RR 0.16; 95% CI 0.08 to 0.34). In both instances the prevention of clinical episodes was favoured by fluconazole. Comparing continuous fluconazole treatment with intermittent treatment (1 RCT; n=62; RR 0.37; 95% CI 0.15 to 0.92), prevention is favoured by the continuous treatment. AUTHORS' CONCLUSIONS Implications for practiceDue to only one study in children it is not possible to make recommendations for treatment or prevention of OC in children. Amongst adults, there were few studies per comparison. Due to insufficient evidence no conclusion could be made about the effectiveness of clotrimazole, nystatin, amphotericin B, itraconazole or ketoconazole with regard to OC prophylaxis. In comparison to placebo, fluconazole is an effective preventative intervention. However, the potential for resistant Candida organisms to develop, as well as the cost of prophylaxis, might impact the feasibility of implementation. No studies were found comparing fluconazole with other interventions. Direction of findings suggests that ketoconazole, fluconazole, itraconazole and clotrimazole improved the treatment outcomes. Implications for researchThere is an urgent need for gentian violet and other less expensive anti-fungal drugs for OC treatment to be evaluated in larger studies. More well designed treatment trials with larger sample size are needed to allow for sufficient power to detect differences in not only clinical, but also mycological response and relapse rates. There is also a strong need for more research to be done on the treatment and prevention of OC in children as it is reported that OC is the most frequent fungal infection in children and adolescents who are HIV positive. More research on the effectiveness of less expensive interventions also needs to be done in resource-poor settings. Currently few trials report outcomes related to quality of life, nutrition, or survival. Future researchers should consider measuring these when planning trials. Development of resistance remains under-studied and more work must be done in this area. It is recommended that trials be more standardised and conform more closely to CONSORT as this will improve research and also clinical practice.
Collapse
Affiliation(s)
- E D Pienaar
- Medical Research council, South African Cochrane Centre, P O Box 19070, Tygerberg, South Africa 7505.
| | | | | |
Collapse
|
45
|
Ramírez-Amador V, Anaya-Saavedra G, Calva JJ, Clemades-Pérez-de-Corcho T, López-Martínez C, González-Ramírez I, Sierra-Madero J. HIV-Related Oral Lesions, Demographic Factors, Clinical Staging and Anti-Retroviral Use. Arch Med Res 2006; 37:646-54. [PMID: 16740437 DOI: 10.1016/j.arcmed.2006.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 01/25/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of the present study was to compare the prevalence of HIV-related oral lesions (HIV-OL) between two health centers for HIV in Mexico City and to analyze the factors that, in addition to combined antiretroviral therapy (CART) and low CD4(+), may be associated with possible differences in prevalence. METHODS A cross-sectional observational study was performed between January 2000 and February 2003 at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), a specialized referral center for HIV/AIDS patients and the Clínica Especializada Condesa (CEC), a primary care center for HIV-infected individuals without social security insurance. A consecutive sample of HIV-infected individuals had an oral examination based on established clinical criteria. Demographic, clinical and laboratory data were obtained. Independent association of each factor with specific HIV-OL was assessed by logistic regression modeling. RESULTS Eight hundred fifty individuals were examined (INCMNSZ: 479; CEC: 371). Hairy leukoplakia (HL), periodontal disease (PD) and Kaposi's sarcoma (KS) were independently associated with the study site [odds ratio (OR) = 1.7 (95% confidence interval (CI): 1.1-2.4), OR = 4.2 (95% CI: 1.3-13), OR = 10.1 (95% CI: 2.7-38.2), respectively], being more frequent in CEC patients. HL was independently associated with men having sex with men OR = 1.7 (95% CI: 1.1-2.8). All HIV-OL were independently associated with CD4(+) counts and, with the exception of PD and KS, with time under CART. CONCLUSIONS The present comparative study showed that several factors were associated with a difference in prevalence of oral lesions found in two AIDS clinics located in Mexico City. Severe immune suppression, CART duration and the study site were associated with HIV-OL. Further investigation into factors such as socioeconomic determinants associated with HIV-OL is warranted.
Collapse
|
46
|
Lin AL, Johnson DA, Sims CA, Stephan KT, Yeh CK. Salivary gland function in HIV-infected patients treated with highly active antiretroviral therapy (HAART). ACTA ACUST UNITED AC 2006; 102:318-24. [PMID: 16920540 DOI: 10.1016/j.tripleo.2005.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2004] [Revised: 06/02/2005] [Accepted: 07/06/2005] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This study was undertaken to determine if HAART alters salivary oral host defense in HIV(+) men. STUDY DESIGN Whole, parotid, and submandibular/sublingual saliva was collected from 39 healthy men and 147 HIV(+) patients with mild to moderate immune dysfunction (69 treated with HAART [HAART(+)]; 78 not treated [HAART(-)]). Salivary flow rates, anticandidal activities, electrolytes, and antimicrobial/antifungal proteins were determined. RESULTS While CD4(+) cell counts were not different between the HIV(+) groups, the median viral load for HAART(-) was 15 times greater than HAART(+). For both HAART groups, salivary yeast carriage rates and concentration were comparable and both showed similar reductions in salivary flow rates. Salivary anticandidal activities were not altered. Saliva composition of both HIV(+) groups was different from control, but only uric acid in parotid saliva of HAART(+) differed from HAART(-). CONCLUSIONS HAART does not adversely affect inherent salivary oral host defense in HIV(+) patients with mild to moderate immune dysfunction.
Collapse
Affiliation(s)
- Alan L Lin
- Department of Dental Diagnostic Science, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | | | | | |
Collapse
|
47
|
Goldman M, Cloud GA, Wade KD, Reboli AC, Fichtenbaum CJ, Hafner R, Sobel JD, Powderly WG, Patterson TF, Wheat LJ, Stein DK, Dismukes WE, Filler SG. A randomized study of the use of fluconazole in continuous versus episodic therapy in patients with advanced HIV infection and a history of oropharyngeal candidiasis: AIDS Clinical Trials Group Study 323/Mycoses Study Group Study 40. Clin Infect Dis 2005; 41:1473-80. [PMID: 16231260 DOI: 10.1086/497373] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Accepted: 06/30/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In human immunodeficiency virus (HIV)-infected patients, fluconazole prophylaxis is associated with reductions in the rate of fungal infection. However, concerns exist with regard to the use of fluconazole prophylaxis and the risk of development of fluconazole treatment-refractory infections. METHODS We performed a randomized, open-label trial that compared oral fluconazole given continuously (200 mg 3 times weekly; the "continuous fluconazole arm") with fluconazole that was provided only for episodes of orophayngeal candidiasis (OPC) or esophageal candidiasis (EC) (the "episodic fluconazole arm") in HIV-infected persons with CD4+ T cell counts of <150 cells/mm3 and a history of OPC. The primary study end point was the time to development of fluconazole-refractory OPC or EC, which was defined as lack of response to 200 mg fluconazole given daily for 14 or 21 days, respectively. RESULTS A total of 413 subjects were randomized to receive continuous fluconazole, and 416 were randomized to receive episodic fluconazole. After 42 months, 17 subjects (4.1%) in the continuous fluconazole arm developed fluconazole-refractory OPC or EC infections, compared with 18 subjects (4.3%) in the episodic fluconazole arm, with no difference between treatment arms with regard to the time to development of a fluconazole-refractory infection within 24 months (P=.88, by log-rank test) or before the end of the study (P=.97, by the log-rank test). Continuous fluconazole therapy was associated with fewer cases of OPC or EC (0.29 vs. 1.08 episodes per patient-year; P<.0001) and fewer invasive fungal infections (15 vs. 28 episodes; P=.04, by chi2 test), but not with improved survival, compared with episodic fluconazole therapy. CONCLUSION Continuous fluconazole therapy is not associated with significant risk of fluconazole-refractory OPC or EC, compared with episodic fluconazole therapy, in HIV-infected patients with access to active antiretroviral therapy.
Collapse
Affiliation(s)
- Mitchell Goldman
- Indiana University School of Medicine, Division of Infectious Diseases, Wishard Memorial Hospital, Indianapolis, IN 46202, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Shiboski CH, Cohen M, Weber K, Shansky A, Malvin K, Greenblatt RM. Factors associated with use of dental services among HIV-infected and high-risk uninfected women. J Am Dent Assoc 2005; 136:1242-55. [PMID: 16196229 DOI: 10.14219/jada.archive.2005.0340] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The authors explored the frequency of dental care utilization and identified the main barriers to access to dental care among U.S. women with HIV infection and uninfected women at high risk of becoming infected. METHODS The authors' prospective study included HIV-infected and uninfected women enrolled in the northern California and Chicago sites of the Women's Interagency HIV Study. A trained interviewer administered a standardized questionnaire to participants by phone. The authors explored subjects' utilization of dental care in relation to predisposing, enabling and need variables using both univariate and multivariate analyses. RESULTS The 363 participants were predominantly black and unemployed and had a history of using injected drugs. Not using dental care was most prevalent among HIV-negative women, particularly in Chicago. Multivariate analyses revealed that the strongest predictors of nonuse of dental care included being of a race other than white, fear of dentists and perception of poor or fair oral health. CONCLUSION Women not infected with HIV but at high risk of developing the infection appear to have even greater unmet dental needs than do HIV-positive women. Being of a race other than white and fear of dentists are strong predictors of not using dental care. PRACTICE IMPLICATIONS The Ryan White Comprehensive AIDS Resources Emergency Act facilitates dental care access for people who are HIV-positive, and is the likely explanation for the higher prevalence of dental care use in this group compared with uninfected women at high risk of becoming infected. This underscores the need for Medicaid to include dental coverage for low-income populations in all states.
Collapse
Affiliation(s)
- Caroline H Shiboski
- Oral Medicine Clinical Center, Department of Orofacial Sciences, University of California San Francisco, San Francisco, Calif, 94143-0422, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
During the past two decades, invasive fungal infections have emerged as a major threat to immunocompromised hosts. Patients with neoplastic diseases are at significant risk for such infections as a result of their underlying illness and its therapy. Aspergillus, Candida, Cryptococcus and emerging pathogens, such as the zygomycetes, dark walled fungi, Trichosporon and Fusarium, are largely opportunists, causing infection when host defences are breached. The immune response varies with respect to the fungal species and morphotype encountered. The risk for particular infections differs, depending upon which aspect of immunity is impaired. This article reviews the current understanding of the role and relative importance of innate and adaptive immunity to common and emerging fungal pathogens. An understanding of the host response to these organisms is important in decisions regarding use of currently available antifungal therapies and in the design of new therapeutic modalities.
Collapse
Affiliation(s)
- Shmuel Shoham
- Section of Infectious Diseases, Washington Hospital Center, Washington, DC, USA
| | | |
Collapse
|
50
|
de Repentigny L, Lewandowski D, Jolicoeur P. Immunopathogenesis of oropharyngeal candidiasis in human immunodeficiency virus infection. Clin Microbiol Rev 2004; 17:729-59, table of contents. [PMID: 15489345 PMCID: PMC523562 DOI: 10.1128/cmr.17.4.729-759.2004] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Oropharyngeal and esophageal candidiases remain significant causes of morbidity in human immunodeficiency virus (HIV)-infected patients, despite the dramatic ability of antiretroviral therapy to reconstitute immunity. Notable advances have been achieved in understanding, at the molecular level, the relationships between the progression of HIV infection, the acquisition, maintenance, and clonality of oral candidal populations, and the emergence of antifungal resistance. However, the critical immunological defects which are responsible for the onset and maintenance of mucosal candidiasis in patients with HIV infection have not been elucidated. The devastating impact of HIV infection on mucosal Langerhans' cell and CD4(+) cell populations is most probably central to the pathogenesis of mucosal candidiasis in HIV-infected patients. However, these defects may be partly compensated by preserved host defense mechanisms (calprotectin, keratinocytes, CD8(+) T cells, and phagocytes) which, individually or together, may limit Candida albicans proliferation to the superficial mucosa. The availability of CD4C/HIV transgenic mice expressing HIV-1 in immune cells has provided the opportunity to devise a novel model of mucosal candidiasis that closely mimics the clinical and pathological features of candidal infection in human HIV infection. These transgenic mice allow, for the first time, a precise cause-and-effect analysis of the immunopathogenesis of mucosal candidiasis in HIV infection under controlled conditions in a small laboratory animal.
Collapse
Affiliation(s)
- Louis de Repentigny
- Department of Microbiology and Immunology, Faculty of Medicine, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
| | | | | |
Collapse
|