Campo J, Del Romero J, Castilla J, García S, Rodríguez C, Bascones A
Department of Bucofacial Medicine and Surgery, Faculty of Odontology, Complutense University of Madrid, Spain.
J Oral Pathol Med. 2002 Jan;31(1):5-10. doi: 10.1034/j.1600-0714.2002.310102.x.
High viral load is currently considered to be one of the main indicators of the progression of HIV-induced immunodepression, but few studies have analysed its relationship to the presence of oral candidiasis (OC). The aim of this cross-sectional study is to analyse the relationship between viral load, total CD4 lymphocyte count, and percentage of CD4 lymphocytes to the occurrence of OC.
The present cross-sectional study included 156 HIV-infected patients seen at a clinic for sexually transmitted diseases and HIV. We assessed the presence or absence of OC, and microbiological samples were obtained from the palatine mucosa and dorsal tongue for a smear stained with KOH (potassium hydroxide) and culture on Sabouraud's dextrose agar in all patients. Viral load was determined by quantification of viral RNA in peripheral blood with a minimum detectable level of 500 RNA copies/ml. CD4+ counts/CD4+ percentage were categorized as <200/<14%, 200-499/14-28%, and >500/>29%, and HIV viral loads were categorized as <500, 500-10,000, >10,000 copies/ml.
Thirty-eight percent (37.8%) of the patients had OC. Patients with CD4+ lymphocyte counts below 200 x 10(6)/l and CD4+ percentages below 14% showed a significantly higher frequency of OC (57.9% and 48.0%, respectively). Patients with a viral load over 10,000 copies/ml also had OC more frequently (44.8%). In the multiple logistic regression analysis, OC showed a statistically significant association with high viral load [>10,000 vs <500, odds ratio (OR)=11.4], low percentage of CD4+ lymphocytes (<14% vs >28%, OR=5), and injection drug use (IDU vs heterosexual transmission, OR=10.2). In HIV-infected patients, high viral load was associated with more frequent OC, regardless of CD4+ lymphocyte level.
These findings suggest that oral candidiasis could be a useful clinical marker of patients with high viral load. In view of these results, emphasis should be placed on the importance of systematic examination of the oral cavity in all medical follow-up examinations of HIV-infected patients.
目前高病毒载量被认为是HIV诱导免疫抑制进展的主要指标之一，但很少有研究分析其与口腔念珠菌病（OC）存在的关系。这项横断面研究的目的是分析病毒载量、总CD4淋巴细胞计数以及CD4淋巴细胞百分比与OC发生之间的关系。
本横断面研究纳入了156名在性传播疾病和HIV诊所就诊的HIV感染患者。我们评估了OC的有无，并从所有患者的腭黏膜和舌背获取微生物样本，用于KOH（氢氧化钾）涂片染色和在沙氏葡萄糖琼脂上培养。通过对外周血中的病毒RNA进行定量来确定病毒载量，最低检测水平为500 RNA拷贝/ml。CD4 +计数/CD4 +百分比分为<200/<14%、200 - 499/14 - 28%和>500/>29%，HIV病毒载量分为<500、500 - 10000、>10000拷贝/ml。
38%（37.8%）的患者患有OC。CD4 +淋巴细胞计数低于200×10⁶/l且CD4 +百分比低于14%的患者OC发生率显著更高（分别为57.9%和48.0%）。病毒载量超过10000拷贝/ml的患者OC发生率也更高（44.8%）。在多因素逻辑回归分析中，OC与高病毒载量[>10000 vs <500，比值比（OR）=11.4]、低CD4 +淋巴细胞百分比（<14% vs >28%，OR = 5）以及注射吸毒（IDU vs异性传播，OR = 10.2）存在统计学显著关联。在HIV感染患者中，无论CD4 +淋巴细胞水平如何，高病毒载量都与更频繁的OC相关。
这些发现表明口腔念珠菌病可能是高病毒载量患者的一个有用临床标志物。鉴于这些结果，应强调在所有HIV感染患者的医学随访检查中系统检查口腔的重要性。
