Oral Candidiasis in High-Risk Patients as the Initial Manifestation of the Acquired Immunodeficiency Syndrome

TLDR

High‑risk individuals—including intravenous‑drug abusers and homosexual or bisexual men—were studied, though it was unclear whether all would progress to AIDS. The study aimed to determine how often unexplained oral candidiasis in high‑risk patients predicts subsequent AIDS. The authors compared 22 high‑risk adults with unexplained oral candidiasis (most with a reversed T4/T8 ratio and generalized lymphadenopathy) to 20 matched high‑risk adults lacking candidiasis but with similar immunologic abnormalities. Unexplained oral candidiasis predicted serious opportunistic infections or AIDS in more than half of high‑risk patients, with 59% developing such events within a median of three months and 80% of those with low T4/T8 ratios progressing to AIDS.

Abstract

We studied the frequency with which unexplained oral candidiasis led to unequivocal acquired immunodeficiency syndrome (AIDS) in patients at risk. Twenty-two previously healthy adults with unexplained oral candidiasis, of whom the 19 tested had a reversed T4/T8 ratio and 20 had generalized lymphadenopathy, were compared with 20 similar patients with a reversed T4/T8 ratio and generalized lymphadenopathy who did not have oral candidiasis. All were intravenous-drug abusers, homosexual or bisexual men, or both. Thirteen of the 22 patients with oral candidiasis (59 per cent) acquired a major opportunistic infection or Kaposi's sarcoma at a median of three months (range, 1 to 23) as compared with none of 20 patients with generalized lymphadenopathy and immunodeficiency but without candidiasis who were followed for a median of 12 months (range, 5 to 21) (P less than 0.001). AIDS developed in 12 of 15 patients with candidiasis and T4/T8 ratios less than or equal to 0.51, as compared with none of four with ratios equal to or greater than 0.60 (P less than 0.01). We conclude that in patients at high risk for AIDS, the presence of unexplained oral candidiasis predicts the development of serious opportunistic infections more than 50 per cent of the time. Whether the remainder will have AIDS is not yet known.