Impact of highly active antiretroviral therapy and Candida spp. oral colonisation in AIDS patients in a Brazilian tertiary-care university hospital
Abstract number: P1803
Delgado A.C., Aoki F.H., Colombo A., Pedro R.J., Resende M., Trabasso P., Oliveira M.S., Moretti M.L.
Objectives: To evaluate Candida spp. oral colonisation in AIDS patients under highly active antiretroviral therapy (HAART).
Methods: prospective cohort study of 331 patients assisted in a University tertiary care hospital. An oral swab was performed and inoculated in CHROMagarCandida. Candida species were determined using ID32C and serotypes of C. albicans were identified by Candida check test. Antifungal susceptibility testing, by microdilution, was performed in all isolates for 5-FC, azoles, amphotericin B, nistatin. Clinical and laboratorial data were collected to identify the association with Candida colonisation. Karyotyping was done in C. albicans isolates.
Results: 161 Candida spp. isolates were detected in 147 (44.4%) patients and C. albicans represented 137(85%) of the isolates followed by C. glabrata (29%); C. tropicalis (16.7%); C. norvegensis (12.5%); C. dubliniensis and C. krusei (8.3%). Seven patients had oral candidiasis at the moment of sampling the oral cavity. All C. albicans were susceptible to all the tested antifungal drugs. Among the non-albicans, six isolates were SDD to fluconazole; nine to itraconazole and seven to cetoconazol. Azole resistance was not detected. Karyotyping showed 15 different profiles in C. albicans serotype A (117strais) and 90% of C. albicans serotype B (18/20 strains) had the same DNA profile. The isolation of Candida was significantly higher in patients with detectable viral load (83/147) (p = 0.0002) and CD4+ T-lymphocyte <200 cells/mm3 (30/83)(p = 0.0003); the median CD4+T cells/mm3 in the colonised group (374.4) was significantly lower than the non-colonized (471.5) (p = 0.003). The incidence of Candida in oral cavity was not different in patients under HAART with or without protease inhibitor (PI) (colonized: 78/133; non colonised: 91/170) (p = 0.60)
Conclusion: Oral Candida colonisation in patients under HAART was associated with low CD4+ T cells/mm3 and failure response to HAART. Despite PI had in vitro antifungal activity, the use of this class of antiretroviral did not influence the presence of Candida in the oral cavity of AIDS patients.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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