RESUMO
BACKGROUND: Mucocutaneous manifestations are one of the first clinical signs in patients infected with human immunodeficiency virus (HIV). To the best of our knowledge, there has been no previous study describing dermatologic manifestations in Mauritanians infected with HIV. The aim of the present study was to determine the profiles of mucocutaneous manifestations in relation to CD4 T cell count in HIV-positive Mauritanian patients. METHODS: A total of 86 adult patients aged > 18 years old attending the Ambulatory Treatment Center of the National Hospital of Nouakchott, Mauritania, with newly diagnosed HIV and who were not under antiretroviral treatment were included in the study in 2015. Dermatologic manifestations were documented before initiating antiretroviral treatment. RESULTS: Most of the included patients were in clinical stage 3 of the World Health Organization classification at initial diagnosis, with the mean CD4 T cell count (± SD) of 514 ± 319 cells/mm3 (range, 2-1328 cells/mm3 ), and 19 of 86 (22.1%) patients had CD4 T cell counts below 200 cells/mm3 . More than half (64%) of newly diagnosed HIV-infected patients had dermatoses, including the following: pruritic papular eruption (44.2%), seborrheic dermatitis (4.7%), Kaposi's sarcoma (3.5%), extensive xerosis cutis (2.3%), drug-induced skin reactions (1.2%), and various infectious dermatoses (dermatophyte infections [16.3%], oral candidiasis [11.6%], herpes zoster [8.1%], and scabies [2.3%]). A low CD4 T cell count (< 200 cells/mm3 ) was significantly correlated (P < 0.05) with the presence of following dermatoses: dermatophytosis, oral candidiasis, Kaposi's sarcoma, seborrheic dermatitis, and extensive xerosis cutis. CONCLUSION: Mucocutaneous lesions occur throughout the course of HIV infection, and dermatologic findings in Mauritanian HIV-positive patients are similar to those of patients in other countries. Early detection of skin disorders in some patients may help establish the diagnosis of HIV and management of HIV-associated diseases, limiting the cost of care in low-resource countries.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/etiologia , Infecções por HIV/complicações , Infecções por HIV/imunologia , Sarcoma de Kaposi/virologia , Dermatopatias Infecciosas/etiologia , Neoplasias Cutâneas/virologia , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adolescente , Adulto , Contagem de Linfócito CD4 , Candidíase Bucal/imunologia , Candidíase Bucal/virologia , Dermatite Seborreica/imunologia , Dermatite Seborreica/virologia , Feminino , Humanos , Masculino , Mauritânia , Pessoa de Meia-Idade , Prurido/imunologia , Prurido/virologia , Sarcoma de Kaposi/imunologia , Dermatopatias Infecciosas/imunologia , Neoplasias Cutâneas/imunologia , Adulto JovemRESUMO
The Oral HIV/AIDS Research Alliance (OHARA) was established in 2006 to provide the capacity to investigate the oral complications associated with HIV/AIDS within the ACTG infrastructure. Its goals were to explore the effects of potent antiretroviral therapy (ART) on the development of opportunistic infections, and variation and resistance of opportunistic pathogens in the context of immune suppression and long-term ART. The objectives of this talk, presented as part of a plenary session at the 7th World Workshop on Oral Health and Disease in AIDS, were to (i) provide an overview of OHARA's most recent research agenda, and how it evolved since OHARA's inception; (ii) describe OHARA's main accomplishments, including examples of research protocols completed and their key findings; and (iii) describe spin-off projects derived from OHARA, lessons learned, and future directions. OHARA has met its central goal and made key contributions to the field in several ways: (i) by developing/updating diagnostic criteria for oral disease endpoints commonly measured in OHARA protocols and in HIV/AIDS research in general and has creating standardized training modules, both for measuring these oral disease endpoints across clinical specialties, and for collecting oral fluid specimens; (ii) by implementing a total of nine protocols, six of which are completed. Three protocols involved domestic research sites, while three involved international research sites (in Africa, India, and South America); (iii) and by developing and validating a number of laboratory assays used in its protocols and in the field of oral HIV/AIDS research.
Assuntos
Pesquisa Biomédica , Candidíase Bucal/imunologia , Infecções por HIV/complicações , Infecções por HIV/imunologia , Infecções por Papillomavirus/imunologia , Sarcoma de Kaposi/virologia , Antirretrovirais/uso terapêutico , Candidíase Bucal/virologia , Infecções por HIV/tratamento farmacológico , Humanos , Infecções por Papillomavirus/virologiaRESUMO
Oropharyngeal candidiasis (OPC) is a very common oral symptom for HIV infected patients. OPC is often caused by overgrowth of commensal Candida strains which asymptomatically colonize oral cavity of HIV+ patients. HIV infection can not only weaken the systemic and local mucosal immunity but also interact with Candida species colonizing in oral cavity. These changes in host immunity and Candida species may facilitate Candida colonization in oral cavity of HIV infected patients. This review will discuss oral Candida colonization (including asymptomatic Candida carriage and OPC) prevalence, colonization spectrum, colonization intensity, relationship between oropharyngeal Candida colonization and peripheral blood CD4+ T cell counts, association of plasma levels of HIV RNA and Candida colonization, and other factors related with Candida colonization in HIV+ patients.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Candidíase Bucal/virologia , Infecções por HIV/microbiologia , Orofaringe/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Linfócitos T CD4-Positivos/imunologia , Candida/imunologia , Candida/isolamento & purificação , Candida/patogenicidade , Candidíase Bucal/complicações , HIV/isolamento & purificação , HIV/patogenicidade , Infecções por HIV/complicações , Infecções por HIV/imunologia , Humanos , Imunidade nas Mucosas/imunologia , Mucosa Bucal/imunologia , RNA Viral/isolamento & purificaçãoRESUMO
BACKGROUND: Oral lichen planus (OLP) is seen frequently in patients with hepatitis C virus (HCV) infection. The aim of this study was to evaluate the occurrence of oral candidiasis, other mucosal lesions, and xerostomia during interferon (IFN) therapy for HCV infection. METHODS: Of 124 patients with HCV-infected liver diseases treated with IFN therapy in our hospital, 14 (mean age 56.00 ± 12.94 years) who attended to receive administration of IFN once a week were identified and examined for Candida infection and other oral lesions and for the measurement of salivary flow. Serological assays also were carried out. RESULTS: Cultures of Candida from the tongue surfaces were positive in 7 (50.0%) of the 14 patients with HCV infection at least once during IFN therapy. C. albicans was the most common species isolated. The incidence of Candida during treatment with IFN did not increase above that before treatment. Additional oral mucosal lesions were observed in 50.0% (7/14) of patients: OLP in three (21.4%), angular cheilitis in three (21.4%) and recurrent aphthous stomatitis in one (7.1%). OLP occurred in one patient before treatment with IFN, in one during treatment and in one at the end of treatment. 85.7% of the oral lesions were treated with topical steroids. We compared the characteristics of the 7 patients in whom Candida was detected at least once during IFN therapy (group 1) and the 7 patients in whom Candida was not detected during IFN therapy (group 2). The prevalence of oral mucosal lesions (P=0.0075) and incidence of external use of steroids (P=0.0308) in group 1 were significantly higher than in group 2. The average body weight of group 1 decreased significantly compared to group 2 (P=0.0088). Salivary flow decreased in all subjects throughout the course of IFN treatment and returned at 6th months after the end of treatment. In group 1, the level of albumin at the beginning of the 6th month of IFN administration was lower than in group 2 (P=0.0550). According to multivariate analysis, one factor, the presence of oral mucosal lesions, was associated with the detection of Candida. The adjusted odds ratio for the factor was 36.00 (95% confidence interval 2.68-1485.94). CONCLUSION: We should pay more attention to oral candidiasis as well as other oral mucosal lesions, in patients with weight loss during IFN treatment.
Assuntos
Antivirais/efeitos adversos , Candidíase Bucal/induzido quimicamente , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/efeitos adversos , Polietilenoglicóis/efeitos adversos , Estomatite/induzido quimicamente , Adulto , Idoso , Antivirais/uso terapêutico , Candidíase Bucal/tratamento farmacológico , Candidíase Bucal/epidemiologia , Candidíase Bucal/microbiologia , Candidíase Bucal/virologia , Feminino , Humanos , Incidência , Interferon-alfa/uso terapêutico , Líquen Plano Bucal/induzido quimicamente , Líquen Plano Bucal/epidemiologia , Líquen Plano Bucal/virologia , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/uso terapêutico , Prevalência , Ribavirina/uso terapêutico , Glândulas Salivares/efeitos dos fármacos , Glândulas Salivares/metabolismo , Glândulas Salivares/virologia , Albumina Sérica/análise , Esteroides/uso terapêutico , Estomatite/tratamento farmacológico , Estomatite/epidemiologia , Estomatite/microbiologia , Resultado do Tratamento , Redução de Peso/efeitos dos fármacosRESUMO
OBJECTIVE: To describe symptoms, physical examination findings, and set-point viral load associated with acute HIV seroconversion in a heterosexual cohort of HIV-discordant couples in Zambia. DESIGN: We followed HIV serodiscordant couples in Lusaka, Zambia from 1995 to 2009 with HIV testing of negative partners and symptom inventories 3 monthly, and physical examinations annually. METHODS: We compared prevalence of self-reported or treated symptoms (malaria syndrome, chronic diarrhea, asthenia, night sweats, and oral candidiasis) and annual physical examination findings (unilateral or bilateral neck, axillary, or inguinal adenopathy; and dermatosis) in seroconverting vs. HIV-negative or HIV-positive intervals, controlling for repeated observations, age, and sex. A composite score comprised of significant symptoms and physical examination findings predictive of seroconversion vs. HIV-negative intervals was constructed. We modeled the relationship between number of symptoms and physical examination findings at seroconversion and log set-point viral load using linear regression. RESULTS: Two thousand, three hundred and eighty-eight HIV-negative partners were followed for a median of 18 months; 429 seroconversions occurred. Neither symptoms nor physical examination findings were reported for most seroconverters. Seroconversion was significantly associated with malaria syndrome among nondiarrheic patients [adjusted odds ratio (aOR)â=â4.0], night sweats (aORâ= 1.4), and bilateral axillary (aORâ=â1.6), inguinal (aORâ=â2.2), and neck (aORâ=â2.2) adenopathy relative to HIV-negative intervals. Median number of symptoms and findings was positively associated with set-point viral load (Pâ<â0.001). CONCLUSION: Although most acute and early infections were asymptomatic, malaria syndrome was more common and more severe during seroconversion. When present, symptoms and physical examination findings were nonspecific and associated with higher set-point viremia.
Assuntos
Astenia/epidemiologia , Candidíase Bucal/epidemiologia , Diarreia/epidemiologia , Soropositividade para HIV/epidemiologia , HIV-1/isolamento & purificação , Malária/epidemiologia , Parceiros Sexuais , Adolescente , Adulto , Astenia/virologia , Candidíase Bucal/virologia , Estudos de Coortes , Diarreia/virologia , Epidemias , Feminino , Seguimentos , Genótipo , Soropositividade para HIV/virologia , HIV-1/imunologia , Heterossexualidade , Humanos , Modelos Lineares , Malária/virologia , Masculino , Pessoa de Meia-Idade , Prevalência , Carga Viral , Viremia , Adulto Jovem , Zâmbia/epidemiologiaRESUMO
We report a 2 year 6 months old girl suffering from HIV infection and presenting with two giant condyloma acuminata of perianal and perivulvar region along with oral candidiasis.
Assuntos
Condiloma Acuminado/virologia , Infecções por HIV/patologia , Antibacterianos/uso terapêutico , Antirretrovirais/uso terapêutico , Candidíase Bucal/tratamento farmacológico , Candidíase Bucal/patologia , Candidíase Bucal/virologia , Pré-Escolar , Condiloma Acuminado/tratamento farmacológico , Evolução Fatal , Feminino , Infecções por HIV/tratamento farmacológico , HumanosRESUMO
BACKGROUND: Oropharyngeal candidiasis (OPC) is the most common opportunistic infection among persons infected with human immunodeficiency virus (HIV). Once-daily miconazole 50 mg buccal tablet (MBT) is a novel delivery system using an extended-spectrum azole with potent in vitro activity against many Candida species, including some that may be resistant to other azoles. METHODS: This phase 3, double-blind, double-dummy, multicenter trial evaluated 578 randomized patients with HIV infection and OPC. The study compared the efficacy and safety of MBT once daily with clotrimazole 10 mg troches (CT) 5 times daily for 14 days. The co-primary efficacy endpoints were clinical cure at test of cure (TOC) visit (days 17-22) in the intent-to-treat (ITT) and per protocol (PP) populations. RESULTS: Clinical cure rate at TOC visit for MBT-treated patients was statistically noninferior to CT-treated patients in both the ITT (61% vs 65%) and PP (68% vs 74%) populations. Secondary endpoints, safety, and tolerability were similar between treatment groups. CONCLUSIONS: In this large trial, once-daily MBT was shown to be noninferior to CT 5 times daily in the treatment of OPC in HIV-positive patients. MBT offers an effective, safe, and well-tolerated topical treatment option for OPC administered as a convenient once-daily dose.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antifúngicos/administração & dosagem , Candidíase Bucal/tratamento farmacológico , Clotrimazol/administração & dosagem , Infecções por HIV/microbiologia , Miconazol/administração & dosagem , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Administração Bucal , Administração Oral , Adulto , Antifúngicos/efeitos adversos , Antifúngicos/sangue , Candida/crescimento & desenvolvimento , Candidíase Bucal/virologia , Distribuição de Qui-Quadrado , Clotrimazol/efeitos adversos , Método Duplo-Cego , Feminino , HIV/crescimento & desenvolvimento , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Masculino , Miconazol/efeitos adversos , Miconazol/sangue , Cooperação do PacienteRESUMO
BACKGROUND: The role of the oral mucosa as a target of human immunodeficiency virus (HIV-1) infection and persistence is unclear. HIV-1 has been reported in oral epithelial cells, but this has not been confirmed. Cellular reservoirs may impede antiretroviral therapies and should be identified. This study was performed to determine the presence of HIV-1 in oral epithelial and Langerhans cells (LCs) of HIV-1-positive antiretroviral naïve patients. Non-invasive brush biopsy technique for future in vivo HIV research was also evaluated. METHODS: Oral mucosal cells were harvested from the buccal mucosae, dorsal tongue and the gingiva of the mandibular teeth of 35 HIV-1-positive patients using a Cytobrush Plus cell collector. Epithelial cells were purified from the samples by flow cytometric cell sorting using cytokeratin stains after which the epithelial cell samples were further purified and divided into superficial and deep epithelial cells by laser microdissection on Pap stained cytospin smears. LCs were picked up individually by laser microdissection from CD1a stained cytospin smears. Purified epithelial and LC samples were tested for the presence of HIV-1 DNA by polymerase chain reaction analysis. RESULTS: Ten of the patients had HIV-1 DNA in one or more of the sampled anatomical locations. No HIV-1 DNA could be demonstrated in any of the purified superficial or deep epithelial or LC samples. CONCLUSIONS: HIV-DNA can be found using non-invasive oral brush biopsies and should be investigated further as an experimental model for in vivo oral HIV research. Better ways to purify the different cell types should be investigated.
Assuntos
HIV-1/fisiologia , Células de Langerhans/virologia , Mucosa Bucal/virologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adolescente , Adulto , Paralisia de Bell/virologia , Contagem de Linfócito CD4 , Candidíase Bucal/virologia , Citodiagnóstico/instrumentação , Citodiagnóstico/métodos , DNA Viral/análise , Cárie Dentária/virologia , Reservatórios de Doenças/virologia , Células Epiteliais/virologia , Feminino , Gengiva/patologia , Gengiva/virologia , Glossite/virologia , Soropositividade para HIV/virologia , HIV-1/genética , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Periodontite/virologia , Língua/patologia , Língua/virologia , Carga Viral , Latência Viral , Adulto JovemRESUMO
OBJECTIVES: To estimate oral disease prevalence among Zimbabwean women by HIV serostatus and CD4 cell count and to assess accuracy of oral disease diagnoses made by nurses as compared with an oral surgeon. METHODS: Standardized oral mucosa examinations were performed by trained nurse-examiners and by an oral surgeon among women recruited in Harare, Zimbabwe. RESULTS: A total of 461 women (320 HIV-infected, 141 uninfected) were seen by nurses and an oral surgeon within a 2-week period. Oral candidiasis (OC) was the most common lesion diagnosed in nearly one quarter of HIV-infected women, whereas hairy leukoplakia and Kaposi sarcoma were found in <3%. The prevalence of OC diagnosed by nurses or the surgeon was significantly higher among women with a CD4 count <200 cells/mm than in women with a CD4 count from 200 to 499 cells/mm3 or a CD4 count >499 cells/mm3. The sensitivity of nurse examinations compared with examinations by the oral surgeon among HIV-infected women for the diagnosis of OC was 73%, the specificity was 95%, and the kappa-statistic was 0.71. CONCLUSIONS: OC was the most common lesion in HIV-infected women and was strongly associated with a low CD4 cell count. Interexaminer agreement was good for the diagnosis of OC among HIV-infected women. This study suggests that OC may play a role, in combination with other clinical indicators as a marker of disease progression in resource-poor settings.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Candidíase Bucal/diagnóstico , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adolescente , Adulto , Contagem de Linfócito CD4 , Candidíase Bucal/virologia , Progressão da Doença , Feminino , Infecções por HIV/virologia , Humanos , Leucoplasia Pilosa/complicações , Leucoplasia Pilosa/virologia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/virologia , Sensibilidade e Especificidade , ZimbábueRESUMO
Oral lesions are common in women and children with HIV/AIDS and may decrease the overall quality of life in these patients because of pain, dry mouth, and difficulty in eating. An oral cavity screening is an easy, noninvasive, quick, and inexpensive procedure that provides nurses with invaluable information about the need for referral, treatment, and health education. Nurses can use the information obtained from a careful oral screening to decrease the symptoms experienced with oral lesions and optimize a patient's ability to chew and enjoy food. Common oral manifestations of HIV infection include fungal, viral, and bacterial infections, although neoplasms, periodontal disease, salivary gland disease, and lesions of uncertain origin are also seen. Oral lesions such as candidiasis, oral hairy leukoplakia, herpetic ulcers, and Kaposi's sarcoma are often among the first symptoms of HIV infection.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Infecções por HIV/complicações , Doenças da Boca , Papel do Profissional de Enfermagem , Saúde Bucal , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Candidíase Bucal/virologia , Criança , Educação em Saúde Bucal , Humanos , Internet , Leucoplasia Pilosa/virologia , Programas de Rastreamento , Doenças da Boca/diagnóstico , Doenças da Boca/prevenção & controle , Doenças da Boca/virologia , Avaliação em Enfermagem , Avaliação Nutricional , Higiene Bucal/educação , Higiene Bucal/enfermagem , Parotidite/virologia , Doenças Periodontais/virologia , Exame Físico/métodos , Exame Físico/enfermagem , Sarcoma de Kaposi/virologia , Estomatite Herpética/virologiaRESUMO
BACKGROUND: Oral lesions are often characteristic in HIV patients and in the majority of cases can be diagnosed by their clinical features alone. To date there is no study addressing the prevalence of oral and perioral lesions in HIV patients in Ethiopia. OBJECTIVES: To assess prevalence of oral and perioral manifestations, the clinical symptoms of oral disease, and to assess the association of oral and perioral lesions to the socio- demographic status and CD4 count of ART naive HIV patients. METHODS: A cross-sectional study on 384 consecutive HIV patients before initiation of ARV treatment was conducted. Oral and perioral lesions were diagnosed according to the EC-clearinghouse's classification and diagnostic criteria for oral lesions in HIV infection and WHO collaborating centre on oral manifestations of HIV, 1992. RESULTS: One hundred and twenty six (32.8%) of the study subjects were males and 258 (67.2%) were females and mean age was 35.4 +/- 9.94 years (range of 14-84 years). Overall prevalence of oral lesions was 64.3%, and perioral lesions was 15.4%. Nearly half (44%) had dental caries. Pseudomembraneous candidiasis (20.1%), linear gingival erythema (11.7%), and erythematous candidiasis (9.1%) were the three most common HIV associated oral lesions. Angular cheilitis (8%) and molluscum contagiosum (4%) were the two most common perioral conditions. The most common oral symptoms reported were dry mouth (34.4%), difficulty eating (27.9%), and oral pain (27.3%). Oral symptoms and a CD4 count < 200 mm(-3) were significantly (X2 = 22.4, P = 0.0001) associated with presence of oral and perioral lesions. Age above 40 years (31%) was significantly associated with oral lesions (P = 0.016), but not with perioral lesions (P = 0.26). CONCLUSION: Oral and perioral lesions were common in HIV positive adults at Tikur Anbessa Specialized hospital and represent a treatable morbidity associated with this disease. Thus, a comprehensive oral examination is important in the clinical evaluation, management, and follow up of patients with HIV.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Transmissão de Doença Infecciosa/estatística & dados numéricos , Infecções por HIV/epidemiologia , Doenças da Boca/virologia , Infecções Oportunistas Relacionadas com a AIDS/complicações , Adolescente , Adulto , Candidíase Bucal/virologia , Estudos Transversais , Etiópia/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/transmissão , HIV-1 , Hospitais de Ensino , Humanos , Leucoplasia Pilosa/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças da Boca/epidemiologia , Doenças Periodontais/epidemiologia , Prevalência , Sarcoma de Kaposi/epidemiologia , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: Oropharyngeal candidiasis (OPC), caused by Candida albicans, is the most common oral infection in HIV(+) persons. Oral epithelial cells are considered important for innate host defense against OPC with production of cytokines in response to C. albicans and the ability to inhibit Candida growth in vitro. The purpose of this study was to determine if Candida similarly induces cytokines by oral epithelial cells from HIV(+) persons, including those with OPC, as well as to determine if cytokines can influence the oral epithelial cell anti-Candida activity. METHODS: Supernatants from oral epithelial cells from HIV(+) persons with and without OPC cultured with Candida were evaluated for cytokines by ELISA, or cytokines were added to the standard growth inhibition assay using epithelial cells from HIV(-) persons. RESULTS: Results showed low Candida-induced epithelial cell cytokine production from HIV(+) persons, but with some elevated proinflammatory cytokines (TNF-alpha, IL-6) in those with OPC compared to those without OPC. The addition of specific proinflammatory or Th cytokines had no effect on oral epithelial cell anti-Candida activity in healthy HIV(-) persons. CONCLUSION: These results suggest that oral epithelial cells from HIV(+) persons can contribute at some level to the oral cytokine milieu in response to Candida during OPC, but that cytokines do not appear to influence oral epithelial cell anti-Candida activity.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Candida albicans/crescimento & desenvolvimento , Candidíase Bucal/virologia , Infecções por HIV/microbiologia , HIV/crescimento & desenvolvimento , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Candidíase Bucal/imunologia , Candidíase Bucal/microbiologia , Estudos de Coortes , Citocinas/biossíntese , Citocinas/imunologia , Citocinas/farmacologia , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/imunologia , Células Epiteliais/microbiologia , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Células Th1/imunologia , Células Th2/imunologiaRESUMO
In this study, we investigated the yeasts colonization of genus Candida, including C. dubliniensis, isolated of HIV-infected patients oral cavities and we accessed in vitro susceptibility pattern of the Candida isolates to four antifungal agents. Out of 99 patients investigated, 62 (62.6%) were colonized with yeasts. C. albicans was the prevailing species (50%). C. dubliniensis isolates were not recovered in our study. We verified that 8.1% of the yeasts isolated were resistant to fluconazole, 8.1% to itraconazole and 3.2% to voriconazole. The isolates demonstrated very low voriconazole MICs, in which 79% (49/62) presented values of 0.015 mug/ml. All Candida isolates were susceptible to amphotericin B. The results reported here showed that although C. albicans continues to be present in one-half of oral Candida carriage of HIV-infected patients, Candida non-albicans species are increasing among these patients. Besides, the findings of resistant isolates endorse the role of antifungal susceptibility testing whenever antifungal treatment with azoles is planned.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candidíase Bucal/microbiologia , Candidíase Bucal/virologia , Infecções por HIV/microbiologia , HIV/crescimento & desenvolvimento , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antifúngicos/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Candidíase Bucal/tratamento farmacológico , Farmacorresistência Fúngica , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Masculino , Testes de Sensibilidade MicrobianaRESUMO
ALS gene expression was studied in the hyposalivatory rat model of oral candidiasis and in clinical specimens collected from HIV-positive patients to assess similarities in expression patterns between the model system and clinical isolates. Two Candida albicans strains, SC5314 and OY-2-76, were used in the rat model system and infection progressed for 3 or 5 days. The strains produced similar oral lesions at 3 days. At 5 days, strain OY-2-76 produced more superficial lesions containing relatively more yeast forms compared to invasive hyphal forms observed for strain SC5314. For all infections, the most severe lesions were observed on the tongue and gingiva overlying the mandible. ALS transcripts were easier to detect by RT-PCR later in infection and under other conditions where more fungal cells were present. Expression of ALS1, ALS2, ALS3 and ALS4 was observed in rats infected for 3 days with ALS5 and ALS9 transcripts detected after 5 days of infection. Expression of ALS6 was observed in a single specimen from a 5-day infection while ALS7 transcript was never found. Expression of all ALS genes was observed in oral clinical material collected from HIV-positive patients although ALS6 and ALS7 transcripts required an extra PCR amplification step to be detected. Overall, the patterns of ALS gene expression were similar between the rat model and human clinical specimens, suggesting that the model would be useful for studying the phenotype of al delta/al delta mutant strains.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Candida albicans/genética , Candidíase Bucal/microbiologia , Proteínas Fúngicas/genética , Infecções por HIV/microbiologia , Xerostomia/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Animais , Candida albicans/metabolismo , Candidíase Bucal/patologia , Candidíase Bucal/virologia , Modelos Animais de Doenças , Feminino , Proteínas Fúngicas/biossíntese , Regulação Fúngica da Expressão Gênica , HIV/crescimento & desenvolvimento , Infecções por HIV/virologia , Histocitoquímica , Humanos , Masculino , Mucosa Bucal/microbiologia , RNA/química , RNA/genética , Ratos , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Anti-Candida activity by oral epithelial cells is considered one of several innate mucosal defense mechanisms against oropharyngeal candidiasis (OPC). OPC is the most common fungal infection in HIV disease. Previously we reported that oral epithelial cell anti-Candida activity is reduced in those with OPC, potentially representing a contributing factor to OPC. However, testing clinical epithelial cells possessing high levels of Candida has been limiting due to high background in the assay controls. HIV+ smokers often develop OPC sooner than non-smokers during progression to AIDS, suggesting additional immune aberrations. The purpose of this study was to design a means to reduce Candida associated with epithelial cells collected from saliva without affecting their in vitro growth inhibitory activity, and to employ that approach to evaluate antifungal activity in HIV+ smokers. To do so, oral epithelial cells with and without known levels of Candida were subjected to various treatments including azole, polyene, or echinocandin antifungal drugs or fixation followed by the standard growth inhibition (GI) assay. The results indicated that antifungal drugs, while effectively reducing cell-associated Candida, also affected epithelial cell function. In contrast, fixation with paraformaldehyde eliminated cell-associated Candida and had minimal effects on epithelial cell anti-Candida activity. Employing the fixation design that allowed a broad range of patients to be evaluated showed no difference in oral epithelial anti-Candida activity between HIV+ smokers and non-smokers. Therefore, oral epithelial cell antifungal activity does not appear compromised in those who smoke, reducing it as a contributing factor in susceptibility to premature OPC.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/imunologia , Candida/imunologia , Candidíase Bucal/imunologia , Infecções por HIV/imunologia , HIV/imunologia , Mucosa Bucal/imunologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Anfotericina B/farmacologia , Antifúngicos/farmacologia , Candida/crescimento & desenvolvimento , Candidíase Bucal/tratamento farmacológico , Candidíase Bucal/virologia , Caspofungina , Equinocandinas , Células Epiteliais/imunologia , Células Epiteliais/microbiologia , Fixadores/farmacologia , Fluconazol/farmacologia , Infecções por HIV/microbiologia , Humanos , Lipopeptídeos , Mucosa Bucal/citologia , Mucosa Bucal/microbiologia , Peptídeos Cíclicos/farmacologia , Fumar/imunologiaRESUMO
OBJECTIVES: To document the incidental oral lesions of human immunodeficiency virus (HIV) infection, the pattern and frequency of the lesions based on clinical presentation and oral manifestations in routine dental patients who tested positive in Nigeria. SUBJECTS AND METHODS: The study was conducted at the Oral Diagnosis/Oral Medicine clinic of the Lagos University Teaching Hospital, Lagos, Nigeria between May 2002 and April 2003. During this period, all patients with oral lesions suggestive of HIV/acquired immunodeficiency syndrome (AIDS) as described in the EEC-WHO Classification and diagnostic criteria of oral lesions of HIV were counseled and offered voluntary HIV testing. All the 35 patients who consented and tested positive were included in this study. RESULTS: Of a total of 700 patients 53 patients with oral lesions suggestive of HIV/AIDS were seen, thirty-eight (72%) consented to HIV screening, 15 patients (28%) refused. Thirty-five patients (92%), mean age 36 +/- 13 years were confirmed positive for HIV. Oral candidiasis was the commonest lesion seen (43%) the second common being Herpes zoster (23%). Other lesions seen included erythema multiforme in two (6%), facial palsy in two (6%) and oral hairy leukoplakia in one (3%). CONCLUSION: An oral mucosal lesion may be the presenting lesion of HIV/AIDS in routine patients attending the dental clinic. Oral health care workers should practice optimal infection control based on the Centers for Disease Control 'Standard Precautions' guidelines on infection control for all patients to minimize occupational transmission of HIV.
Assuntos
Candidíase Bucal/virologia , Infecções por HIV/diagnóstico , Herpes Zoster/virologia , Doenças Periodontais/virologia , Adolescente , Adulto , Idoso , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Pessoa de Meia-Idade , NigériaRESUMO
Oral opportunistic infections in the HIV-positive individual have been documented since the first reports of the epidemic, with many lesions associated with reduced CD4(+) T lymphocyte cell count. The most common oral lesions seen in HIV disease prior to the advent of highly active antiretroviral therapy (HAART) were oropharyngeal candidiasis and oral hairy leukoplakia. However, since the advent of HAART while many oral lesions have decreased significantly the incidence of oral warts has surprisingly increased. Despite the correlation of diminished CD4(+) T lymphocyte count to the occurrence of these lesions, it is rare for the lesions to occur concurrently suggesting that each pathologic lesion type is associated with distinct host immune dysfunctions. To date, the oral opportunistic infection most frequently investigated is oropharyngeal candidiasis, where data suggests that both systemic and local immunity is important for protection against infection. In contrast, recent investigations into the host responses associated with oral hairy leukoplakia and oral warts show little to no evidence of systemic or mucosal immune responsiveness despite the presumed competence of several types of leukocytes other than CD4(+) T cells. Together these data are suggesting that susceptibility to oropharyngeal candidasis in HIV-positive persons is predominantly immune-based, whereas protection or susceptibility to oral hairy leukoplakia and oral warts may be more associated with factors other than mucosal immune function.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/imunologia , Doenças da Boca/imunologia , Doenças da Boca/virologia , Mucosa Bucal/imunologia , Mucosa Bucal/virologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Candidíase Bucal/epidemiologia , Candidíase Bucal/imunologia , Candidíase Bucal/virologia , Humanos , Leucoplasia Pilosa/epidemiologia , Leucoplasia Pilosa/imunologia , Leucoplasia Pilosa/virologia , Modelos Imunológicos , Doenças da Boca/epidemiologia , Verrugas/epidemiologia , Verrugas/imunologia , Verrugas/virologiaRESUMO
PURPOSE: To describe baseline prevalence of oral mucosal diseases among HIV infected adolescents in relationship to biological and behavioral risk factors. METHODS: Participants in Reaching for Excellence in Adolescent Care and Health (REACH), a multicenter longitudinal observational study of HIV/AIDS in adolescents, received physical examinations, blood tests, and oral examinations at 3-month intervals. We evaluated participants for oral conditions commonly seen in relationship to HIV, and explored the association of the most common lesion with selected biological and behavioral variables at baseline using contingency tables and Fisher's Exact test. RESULTS: Among 294 HIV infected adolescents recruited between March 1996 and March 1999, the majority were female (75%), aged 17 to 18 years (69%), and African-American (73%). More than 90% had a CD4(+) T-lymphocyte count > 200 cells/mm(3) at baseline and 57% had a plasma HIV-1 RNA concentration Assuntos
Candidíase Bucal/etiologia
, Infecções por HIV/complicações
, Leucoplasia Pilosa/etiologia
, Adolescente
, Candidíase Bucal/virologia
, Estudos de Coortes
, Feminino
, Humanos
, Leucoplasia Pilosa/virologia
, Masculino
, RNA Viral/análise
, Estomatite Aftosa/etiologia
, Estomatite Aftosa/virologia
RESUMO
The objective of this work was to assess the prevalence of human immunodeficiency virus-related oral lesions (HIV-ROL) in HIV-positive/acquired immunodeficiency syndrome (AIDS) patients receiving highly active antiretroviral therapy (HAART) including HIV-protease inhibitors. One hundred fifty-five (154) AIDS patients (69 intravenous drug users [IDU], 53 heterosexuals, 29 males who have sex with males, 1 transfused, and 2 of unknown contagious source) receiving HAART, were examined. We found the following prevalences: HIV-ROL 53.2%; oral candidiasis 34.4%; hairy leucoplakia 26.6%; xerostomia 15.5%; herpes simplex labialis 1.9%; HIV/periodontitis-gingivitis 0.6%. No cases of Kaposi's sarcoma were observed. The highest prevalence of HIV-ROL was found in the IDU group, and in patients with viral load more than 10,000 copies and CD4(+) cell count less than 200. Using our historical controls, this suggests that the prevalence of all oral lesions, particularly oral candidiasis, herpes simplex labiali, Kaposi's sarcoma, and periodontal disease has decreased more than 30% after the institution of HAART.