ABSTRACT
Oral candidiasis is the most common fungal infection of the mouth seen in association with HIV infection and has been reported to occur in more than 90% of HIV-positive people (1). Although oral candidiasis is more common as the CD4 count falls below 300 cells/mm3, it may also occur in association with acute or primary infection (2). Oral candidiasis is widely recognized as representing an important stage in the natural history of HIV infection in adults and children (3,4). Approximately 4% of HIVinfected homosexual and bisexual men followed from seroconversion develop candidiasis within 1 year, 14% within 2 years, and 26% within 5 years (5). Pseudomembranous and erythematous candidiasis were equally significant markers in the progression of HIV disease in homosexual men, independent of CD4 count (6). Oral candidiasis in women has been associated with falling CD4 counts (7) and appears after vaginal candidiasis occurs (8). Development of hairy leukoplakia or oral candidiasis was associated with the risk of progression and development of AIDS (5,9). Several studies have suggested that the same strain of Candida is carried throughout life, others have shown that individuals acquire different strains (10-12). These acquired strains may be more virulent. Candida albicans is the most common species identified with oral candidiasis, but other species such as C. glabrata, C. tropicalis, and C. krusei are seen. The presence of species other than C. albicans may have important implications for treatment, as some of these species have different susceptibilities to antifungal agents (13). Candida albicans is frequently recovered from the
oral cavity as part of the normal oral flora in 10% to 70% of individuals (14,15). Other factors may contribute to the development of oral candidiasis and may influence response to therapy. These include the use of medications such as recent or concomitant use of antibiotics, steroids including inhaled steroids, wearing dentures, dry mouth, and smoking.
