Spectrum of oral candidiasis in HIV/AIDS: treatment and response to various antifungal agents in a tertiary hospital in Abuja

Abstract

Background: Oral candidiasis is one of the commonest opportunistic infections seen in people with Human Immunodeficiency Virus/Acquired Immune deficiency Syndrome (HIV/AIDS) infection. Although oral candidiasis can occur at any stage of HIV infection, it is more predominant in patients with declining CD₄⁺ count. Majority of the candida isolates are Candida albicans and they are sensitive to topical/systemic antifungal agents such as fluconazole, itraconazole and oral nystatin.

Objective: This study seeks to identify the candida species implicated in oral candidiasis among HIV/AIDS patients and the response rate to various antifungal agents used in our facility.

Methodology: This is a prospective study of all HIV/AIDS infected patients admitted into our facility over a period of nine months (December 2016- August 2017) and were clinically diagnosed with oral candidiasis. A proforma was designed to capture their bio-data, symptoms such as burning sensations in the mouth, odynophagia, dysphagia and clinical types of oral candidiasis. Their CD₄⁺ count, liver function test, full blood count, candida species isolation and their treatment response were noted and documented.

Results: Of the 312 HIV/AIDS infected patients admitted, 82(26.3%) had clinically diagnosed oral candidiasis. Candida albicans accounted for 79.3%, and Candida dubliniensis accounted for 7.3%. The mean CD₄⁺ count was 94.4cells/μl and 55.0% of those who had oral candidiasis responded to Itraconazole within seven days of therapy.

Conclusion: The most common specie isolated among HIV infected patients admitted at the University of Abuja Teaching Hospital was Candida albicans and its response to itraconazole was good even at a low CD₄⁺ count.

Keywords: Immunosuppression, Candidasis, CD₄⁺count, Fluconazole, Itraconazole, Nyastin