Role of oral candidiasis in TB and HIV co-infection: AIDS Clinical Trial Group Protocol A5253.

Abstract

OBJECTIVE:

To evaluate the association between oral candidiasis and tuberculosis (TB) in human immunodeficiency virus (HIV) infected individuals in sub-Saharan Africa, and to investigate oral candidiasis as a potential tool for TB case finding.

METHODS:

Protocol A5253 was a cross-sectional study designed to improve the diagnosis of pulmonary TB in HIV-infected adults in high TB prevalence countries. Participants received an oral examination to detect oral candidiasis. We estimated the association between TB disease and oral candidiasis using logistic regression, and sensitivity, specificity and predictive values.

RESULTS:

Of 454 participants with TB culture results enrolled in African sites, the median age was 33 years, 71% were female and the median CD4 count was 257 cells/mm(3). Fifty-four (12%) had TB disease; the prevalence of oral candidiasis was significantly higher among TB cases (35%) than among non-TB cases (16%, P < 0.001). The odds of having TB was 2.4 times higher among those with oral candidiasis when controlling for CD4 count and antifungals (95%CI 1.2-4.7, P = 0.01). The sensitivity of oral candidiasis as a predictor of TB was 35% (95%CI 22-48) and the specificity 85% (95%CI 81-88).

CONCLUSION:

We found a strong association between oral candidiasis and TB disease, independent of CD4 count, suggesting that in resource-limited settings, oral candidiasis may provide clinical evidence for increased risk of TB and contribute to TB case finding.

• Authors: C H Shiboski, H Chen, M A Ghannoum, L Komarow, S Evans, P K Mukherjee, N Isham, D Katzenstein, A Asmelash, A E Omozoarhe, S Gengiah, R Allen, S Tripathy, S Swindells, AIDS Clinical Trials Group Network and Oral HIV/AIDS Research Alliance
• Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease (Int J Tuberc Lung Dis) Vol. 18 Issue 6 Pg. 682-8 (Jun 2014) ISSN: 1815-7920 [Electronic] France
• PMID: 24903939 (Publication Type: Evaluation Study, Journal Article, Research Support, N.I.H., Extramural)

Topics

• Adolescent
• Adult
• Africa South of the Sahara (epidemiology)
• Aged
• CD4 Lymphocyte Count
• Candidiasis, Oral (diagnosis, epidemiology, immunology, microbiology)
• Chi-Square Distribution
• Coinfection
• Cross-Sectional Studies
• Female
• HIV Infections (diagnosis, epidemiology, immunology, virology)
• Humans
• Logistic Models
• Male
• Middle Aged
• Odds Ratio
• Predictive Value of Tests
• Prevalence
• Risk Assessment
• Risk Factors
• Tuberculosis, Pulmonary (diagnosis, epidemiology, immunology, microbiology)
• Young Adult