Predisposing factors for oropharyngeal colonization of yeasts in human immunodeficiency virus-infected patients: a prospective cross-sectional study.

BACKGROUND: Oropharyngeal candidiasis continues to be a major opportunistic infection in human immunodeficiency virus (HIV)-infected patients. The objectives of this study were to investigate the prevalence, associated factors, and microbiologic features for oropharyngeal yeast colonization in HIV-infected patients. METHODS: From October to December 2009, consecutive HIV-infected patients older than 18 years were recruited in this study. Demographic information, underlying conditions, and clinical histories were collected. Oropharyngeal swab cultures for yeasts and antifungal drug susceptibilities of the isolates were performed. RESULTS: Of the 105 HIV-infected patients, 54 (51.4%) were colonized with yeasts, including 11 patients (20.4%) with more than one species. Among the 68 isolates, Candida albicans accounted for 73.5%, followed by Candida tropicalis (5.9%), Candida glabrata (5.9%), and Candida dubliniensis (4.4%). There were 7.5% and 6% Candida isolates resistant to fluconazole and voriconazole, respectively. All of the Candida isolates were susceptible to amphotericin B. A higher prevalence of yeast colonization was noted in patients with a CD4 cell count ≤200 cells/µL (p = 0.032). Multivariate regression analysis showed that intravenous drug use was an independent associated factor for oropharyngeal yeast colonization (odds ratio, 5.35; 95% confidence interval, 1.39-20.6; p = 0.015), as well as protease inhibitor-containing antiretroviral therapy (odds ratio, 3.59; 95% confidence interval, 1.41-9.12; p = 0.007). CONCLUSION: Despite previous studies showing that protease inhibitors decreased Candida adhesion to epithelial cells in vitro, the current study found protease inhibitor-containing antiretroviral therapy predisposed to oropharyngeal yeast colonization in HIV-infected patients.

Distinct impacts of syndesmophyte formation on male and female patients with ankylosing spondylitis.

AIM: Ankylosing spondylitis (AS), a chronic inflammatory autoimmune disease, mainly affects the axial skeleton, leading to sacroiliitis and rigidity of the spine. Both spinal rigidity and syndesmophyte development can affect bone formation and resorption. In addition, inflammatory cytokines and cell adhesion molecules are correlated with bone metabolism. The aim of this study was to investigate the effects of gender difference and syndesmophyte formation on cytokines, adhesion molecules and bone metabolism markers in AS patients. METHOD: Eighty-seven AS patients (68 males, 19 females) were enrolled in this study. Electrochemiluminescence immunoassay and enzyme-linked immunosorbent assay were performed to measure studied parameters. RESULTS: Regarding gender, the serum levels of C-terminal crosslinking telopeptide of type I collagen (CTX), vascular endothelial growth factor, soluble vascular cell adhesion molecule-1, tumor necrosis factor alpha and interleukin (IL)-18 in male patients were all significantly higher than those in female patients. The serum levels of osteocalcin and type I procollagen N-terminal propeptide showed downward trends, whereas CTX and parathyroid hormone concentrations were remarkably lower and IL-18 levels were significantly higher in male AS patients with syndesmophytes compared to those without syndesmophytes. In female patients, CTX and IL-6 levels in those with syndesmophytes were significantly higher than in those without syndesmophytes. Cytokines, adhesion molecules and bone metabolism markers were all positively related with syndesmophyte formation and gender differences. CONCLUSION: AS patients with syndesmophytes experienced imbalance of bone metabolism due to inflammatory cytokine release. Male AS patients had high levels of bone resorption markers, cytokines and adhesion molecules, reflecting a disorder of bone metabolism.

Risk factors of isolated antibody against core antigen of hepatitis B virus: association with HIV infection and age but not hepatitis C virus infection.

BACKGROUND: Isolated antibody to hepatitis B core antigen (anti-HBc) is defined as seropositivity for anti-HBc in the absence of hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs). It is commonly found in HIV-infected persons or hepatitis C virus (HCV)-infected persons, but the risk factors for isolated anti-HBc remain uncertain, especially in regions that are hyperendemic for hepatitis B virus (HBV) infection. METHODS: This cross-sectional study included a cohort of 955 nonhemophiliac, HIV-infected patients, diagnosed between 1988 and 2009, and 643 HIV-uninfected injection drug users (IDUs) attending the methadone clinic between August 2007 and May 2009, with available HBV serological data. The medical records were reviewed to identify the risk factors associated with seropositivity of isolated anti-HBc. RESULTS: The overall seroprevalence of isolated anti-HBc was 12.1% (193 of 1598), in which occult HBV infection accounted for 1.6% (3 of 185) and the majority (91.2 %, 176 of 193) had low titers of anti-HBs (3.6 +/- 2.9 IU/L). Subjects with isolated anti-HBc were significantly older (40.7 +/- 9.3 versus 36.9 +/- 8.0, respectively, P < 0.0001). There was a significantly increasing trend in the prevalence of isolated anti-HBc with age, from 4.0% in those younger than 30 years to 22.5% after 50 years of age (test for trend, P < 0.0001). A significantly higher prevalence of isolated anti-HBc was observed in HIV-infected subjects [14.0% (134 of 955) versus 9.2% (59 of 643), adjusted odds ratio, 1.64; P < 0.01], but not in those with HCV infection (P = 0.18). CONCLUSIONS: Isolated anti-HBc seropositivity was significantly associated with HIV infection, and older age. HCV infection was not associated with isolated anti-HBc in a country hyperendemic with HBV infection, even in populations with a high prevalence of HCV infection. The majority was not attributable to occult HBV infection, but rather, low level of anti-HBs, suggesting that HBV vaccination may not be required.