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

Abstract

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