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Adv Dent Res 19:130-138, April, 2006
© 2006 International and American Associations for Dental Research

(B1) Candida and Mycotic Infections

Presented at the Fifth World Workshop on Oral Health and Disease in AIDS, Phuket, Thailand, July 6–9, 2004, sponsored by Prince of Songkla University, Thailand, the International Association for Dental Research, the World Health Organization, the NIDCR/National Institutes of Health, USA, and the University of California-San Francisco Oral AIDS Center.

M.M. Coogan1,*, P.L. Fidel, Jr.2, M.C. Komesu3, N. Maeda4, and L.P. Samaranayake5

1 Division of Oral Microbiology, School of Dentistry, University of the Witwatersrand, Private Bag X6, Wits 2050, Johannesburg, South Africa
2 Department of Microbiology, Immunology and Parasitology, Louisiana State University Medical Center, New Orleans, LA, USA
3 Department of Morphology, Stomatology and Physiology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
4 Department of Oral and Maxillofacial Surgery, Tokyo, Japan; and
5 Oral Biosciences, Faculty of Dentistry, University of Hong Kong

Correspondence: * corresponding author, cooganm{at}dentistry.wits.ac.za

Oral candidiasis (OC) is the most common mucosal manifestation of HIV infection. This workshop examined OC and other mycoses associated with HIV infection. Historically, blood CD4 cell numbers were the primary prognosticator for the development of OC. However, a study that statistically evaluated the predictive role of HIV viral load vs. CD4 cell counts revealed viral load to be a stronger predictor for OC. The role of biofilms and antifungal resistance in recalcitrant OC is unclear at present. In general, micro-organisms including yeasts in biofilms are more resistant to antifungals than their planktonic counterparts. When the remaining organisms are eliminated, the few resistant organisms may not be problematic, because they are present in low numbers. Unusual exotic mycoses in HIV-infected patients are more common in patients from the developing than the developed world. These infections may be recurrent and recalcitrant to therapy, be present in multiple and uncommon sites, increase with the progression of HIV disease, and may play a role similar to that of the more common mycoses. Typing and subtyping of yeasts are probably not critical to the clinical management of candidiasis caused by Candida albicans and non-albicans strains, including C. dubliniensis, because it is responsive to antifungal therapy. C. glabrata is probably the only exception. The presence of oral thrush in infants younger than 6 months of age is associated with an increased post-natal transmission risk of HIV infection. Thus, perinatal retroviral therapy should be combined with the treatment of oral thrush to prevent the post-natal acquisition of HIV.

KEY WORDS: Oral candidiasis • viral load • biofilms • exotic mycoses • Candida typing • HIV acquisition






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