+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Factors associated with esophageal candidiasis and its endoscopic severity in the era of antiretroviral therapy

Factors associated with esophageal candidiasis and its endoscopic severity in the era of antiretroviral therapy

Plos one 8(3): E58217

Candidia esophagitis (CE) is an AIDS-defining condition, usually occurring in individuals with low CD4 counts of <200 cells/µL. Endoscopy is a valuable definitive diagnostic method for CE but may not be indicated for asymptomatic patients or for those with high CD4 counts or without oral candidiasis. This study assessed such patients to clarify the factors associated with CE and its severity on endoscopy in the highly active antiretroviral therapy (HAART) era. A total of 733 HIV-infected patients who underwent upper gastrointestinal (GI) endoscopy were analyzed. Sexual behavior, CD4(+) count, HIV-RNA viral load (VL), history of HAART, GI symptoms, GI diseases, and oral candidiasis were assessed. Endoscopic severity of CE was classified as mild (Kodsi's grade I/II) or severe (grade III/IV). Of the 733 subjects, 62 (8.46%) were diagnosed with CE (mild, n = 33; severe, n = 29). Of them, 56.5% (35/62) had no GI symptoms, 30.6% (19/62) had CD4 + ≥200 cells/μL, and 55.3% (21/38) had no oral candidiasis. Univariate analysis found lower CD4+ counts, higher HIV VL, and no history of HAART to be significantly associated with CE. With lower CD4(+) counts and higher HIV VL, CE occurrence increased significantly (P<0.01 for trend in odds). Multivariate analysis showed low CD4+ counts and high HIV VL to be independently associated with CE. Of the severe CE patients, 55.2% (16/29) had no GI symptoms and 44.4% (8/18) had no oral candidiasis. Median CD4(+) counts in severe cases were significantly lower than in mild cases (27 vs. 80; P = 0.04). Low CD4+ counts and high HIV VL were found to be factors associated with CE, and advanced immunosuppression was associated with the development of severity. Endoscopy is useful as it can detect CE, even severe CE, in patients without GI symptoms, those with high CD4 counts, and those without oral candidiasis.

Please choose payment method:

(PDF emailed within 1 workday: $29.90)

Accession: 053193045

Download citation: RISBibTeXText

PMID: 23555571

Related references

Relationship between clinical factors and severity of esophageal candidiasis according to Kodsi's classification. Diseases of the Esophagus 27(3): 214-219, 2014

Esophageal candidiasis in human immunodeficiency virus-infected pediatric patients after the introduction of highly active antiretroviral therapy. Pediatric Infectious Disease Journal 21(5): 388-392, 2002

Long-Term Trends in Esophageal Candidiasis Prevalence and Associated Risk Factors with or without HIV Infection: Lessons from an Endoscopic Study of 80,219 Patients. Plos one 10(7): E0133589, 2015

Immunological and epidemiological factors affecting candidiasis in HIV patients beginning antiretroviral therapy in an Asian clinic. Archives of Oral Biology 82: 86-91, 2017

Factors of failure in fluconazole therapy of oral and esophageal candidiasis in HIV-infected patients. Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 35: 96, 1995

Pulsatile Wave in Esophageal Wall Blood Vessels after Endoscopic Therapy for Esophageal Varices : Evaluation by Endoscopic Color Doppler Ultrasonography. Digestive Endoscopy 10(1): 9-13, 1998

Esophageal candidiasis. The clinical and endoscopic aspects. Minerva Medica 83(4): 193-196, 1992

The potential of photodynamic therapy to treat esophageal candidiasis coexisting with esophageal cancer. Journal of Photochemistry and Photobiology. B Biology 130: 305-309, 2014

Association of esophageal candidiasis with acute hiv infection and the value of esophageal candidiasis as a diagnostic criterion for aids. Viii International Conference on Aids And The Iii Std World Congress Viii International Conference on Aids And The Iii Std World Congress; Harvard-Amsterdam Conference, Amsterdam, Netherlands, July 19-24, Pagination Varies Viii International Conference on Aids And The Iii Std World Congress: Amsterdam, Netherlands Paper : b228, 1992

Factors affecting successful endoscopic sclero therapy for esophageal varices. Gut 24(10): 946-949, 1983

Clinical studies of esophageal candidiasis at the department of otolaryngology with endoscopic findings. Journal of Tokyo Women's Medical College 55(2): 211-215, 1985

Esophageal candidiasis in AIDS. Clinical, endoscopic, and histopathologic analysis of 19 cases. Revista de Investigacion Clinica; Organo del Hospital de Enfermedades de la Nutricion 43(2): 124-127, 1991

Oropharyngeal candidiasis in the era of antiretroviral therapy. Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics 109(4): 488-495, 2010

Adherence to antiretroviral therapy: factors independently associated with reported difficulty taking antiretroviral therapy in a national sample of HIV-positive Australians. HIV Medicine 12(9): 562-569, 2011

Factors influencing antiretroviral therapy adherence among HIV-infected people on antiretroviral therapy in Ili Kazakh Autonomous Prefecture. Zhonghua Yu Fang Yi Xue Za Zhi 51(2): 160-164, 2017