Factors associated with time free of oral candidiasis in children living with HIV/AIDS, São Paulo, Brazil.

In clinical practice, recurrence of thrush is common in children living with HIV/AIDS. The aim of this study was to determine the factors associated with time spent free of oral candidiasis using survival analysis for recurrent events. A retrospective cohort study was carried out with 287 children treated between 1985 and 2009 at a reference center in the city of São Paulo, Brazil. The Prentice, Williams and Peterson model for recurrent events was used for the investigation of factors associated with the time free of oral candidiasis. The following factors were associated with the time patients were free of oral candidiasis: moderate immunodepression (HR = 2.5; p = 0.005), severe immunodepression (HR = 3.5; p < 0.001), anemia (HR = 3.3; p < 0.001), malnutrition (HR = 2.6; p = 0.004), hospitalization (HR = 2.2; p < 0.001), monotherapy (HR = 0.5; p = 0.006), dual therapy (HR = 0.3; p < 0.001) and triple therapy/highly active antiretroviral therapy (HR = 0.1; p < 0.001). The method analyzed in the present study proved useful for the investigation of recurrent events in patients living with HIV/AIDS.

Factors associated with time free of oral candidiasis in children living with HIV/AIDS, São Paulo, Brazil / Fatores associados ao tempo livre de candidíase oral em crianças vivendo com HIV/AIDS, São Paulo, Brasil / Factores asociados al tiempo libre y la candidiasis oral en niños que viven con VIH/SIDA, São Paulo, Brasil

In clinical practice, recurrence of thrush is common in children living with HIV/AIDS. The aim of this study was to determine the factors associated with time spent free of oral candidiasis using survival analysis for recurrent events. A retrospective cohort study was carried out with 287 children treated between 1985 and 2009 at a reference center in the city of São Paulo, Brazil. The Prentice, Williams and Peterson model for recurrent events was used for the investigation of factors associated with the time free of oral candidiasis. The following factors were associated with the time patients were free of oral candidiasis: moderate immunodepression (HR = 2.5; p = 0.005), severe immunodepression (HR = 3.5; p < 0.001), anemia (HR = 3.3; p < 0.001), malnutrition (HR = 2.6; p = 0.004), hospitalization (HR = 2.2; p < 0.001), monotherapy (HR = 0.5; p = 0.006), dual therapy (HR = 0.3; p < 0.001) and triple therapy/highly active antiretroviral therapy (HR = 0.1; p < 0.001). The method analyzed in the present study proved useful for the investigation of recurrent events in patients living with HIV/AIDS.

A recorrência da candidíase oral em crianças vivendo com HIV/AIDS é um acontecimento muito comum na prática clínica. O objetivo foi verificar os fatores associados ao tempo livre de candidíase oral, utilizando técnica de análise de sobrevida para eventos recorrentes. Estudo de coorte retrospectivo com 287 crianças, atendidas entre 1985 e 2009, em um serviço de saúde de São Paulo, Brasil. Foi utilizado o modelo marginal para eventos recorrentes de Prentice, Williams e Peterson para investigação dos fatores associados ao tempo livre de candidíase oral. Imunodepressão moderada (HR = 2,5; p = 0,005) ou grave (HR = 3,5; p < 0,001), anemia (HR = 3,3; p < 0,001), desnutrição (HR = 2,6; p = 0,004) e internação (HR = 2,2; p < 0,001), monoterapia (HR = 0,5; p = 0,006), terapia dupla (HR = 0,3; p < 0,001) e terapia tripla/HAART (HR = 0,1; p < 0,001) foram associados ao tempo livre de candidíase oral. A metodologia apresentada neste artigo pode ser bastante útil em pesquisas na área de HIV/AIDS, quando pretende-se estudar eventos com comportamento de recorrência.

La repetición de candidiasis oral en los niños que viven con VIH/SIDA es muy común en la práctica clínica. El objetivo fue verificar los factores asociados al tiempo libre y la candidiasis oral, usando la técnica de análisis de supervivencia para eventos recurrentes. Se realizó un estudio de cohorte retrospectiva con 287 niños que visitaron entre 1985 y 2009 un servicio de salud de São Paulo, Brasil. Se usó el modelo marginal para eventos recurrentes de Prentice, Williams y Peterson, con el fin de investigar los factores asociados. Moderada inmunodepresión (HR = 2,5; p = 0,005) o grave (HR = 3,5; p < 0,001), anemia (HR = 3,3; p < 0,001), desnutrición (HR = 2,6; p = 0,004) y hospitalización (HR = 2,2; p < 0,001), monoterapia (HR = 0,5; p = 0, 006), terapia dual (HR = 0,3; p < 0,001) y triple terapia/TARGA (HR = 0,1; p < 0,001) se asociaron al tiempo libre y la candidiasis oral. La metodología presentada en este artículo puede ser útil para la investigación en el área de VIH/SIDA, cuando se pretenda estudiar el comportamiento de la repetición del evento.

[Candidiasis in AIDS patients]. / Candidíase em pacientes aidéticos.

UNLABELLED: A total of 35 in patients admitted at Emilio Ribas Hospital--São Paulo, Brazil, with digestive candidiasis and AIDS clinical diagnostic were evaluated 10 month later, being 29 male and 6 female; white outnumbering black with age ranged from 30 to 50 years old. Agar Sabouraud culture and tube germinative tests identified 28 (80%) Candida albicans out 35 strains. Minimum inhibitory concentration (MIC) 50% was against azoles (ketoconazole = 2.2 micrograms/ml; itraconazole = 21.0 micrograms/ml and fluconazole = 19.0 micrograms/ml); polyenes (nystatin = 50.0 micrograms/ml and amphotericin B = 0.12 micrograms/ml) and 5 fluorocytosine = 1.6 micrograms/ml. Siegel tests showed significant Candida albicans proportions in strains isolated from 35 AIDS patients. There was no significant relation between AMB doses and early or late death. CONCLUSIONS: candidiasis in AIDS patients showed high MIC 50% to azoles and nystatin and significant Candida albicans proportion in all strains isolated from AIDS patients. Previous amphotericin B therapy had no influence in early or late death in 30 patients. Previous therapy possibly explained MIC 50% increases in Candida strains.