Prevalence and Associated Risk Factors of Oropharyngeal Candidiasis among Sero-positive HIV Patients in Southwestern Nigeria

Background: Oropharyngeal candidiasis (OPC) is a very common opportunistic infection among HIV-positive patients, particularly in resource-limited settings. Although antiretroviral therapy is widely accessible, OPC continues to pose a major clinical challenge, particularly in sub-Saharan Africa. This study sought to explore and determine the risk factors linked to OPC in HIV-positive patients in Southwestern Nigeria. Materials and Methods: A prospective observational study was carried out at the PEPFAR adult clinic of Olabisi Onabanjo University Teaching Hospital in Sagamu, Nigeria, between February 2021 and January 2022. The study enrolled 411 consenting HIV-positive adult patients. Data collection involved the use of questionnaires, clinical examinations and laboratory analyses. Oral swabs were cultured on Sabouraud dextrose agar, and Candida species were identified through colonial morphology, microscopic characteristics, chrome agar identification, and API 20C kit tests. The data were analysed using SPSS version 17, with a statistical significance threshold of P < 0.05. Results: Out of the 411 participants, 324 (78.8%) were female, while 87 (21.2%) were male. The average age of the participants was 44.9 years, and the mean CD4 count was 477.1 cells/μL. Thirty (7.3%) participants had clinical features of OPC, while 82 (20.0%) had Candida species isolated from their oral cavity. Significant associations were found between Candida colonisation and low CD4 counts (<200 cells/μL, χ² =69.0504, P < 0.001), high viral load (>1000 copies/mL, χ² =17.3395, P < 0.001) and infrequent oral hygiene practices (χ² =6.22, P = 0.045). Smoking and alcohol consumption also showed significant associations with Candida colonisation (χ² =1.007 and 0.219, respectively). Conclusion: The study underscores the critical impact of immunosuppression, inadequate oral hygiene and lifestyle factors such as smoking and alcohol use on the development of OPC in HIV-positive patients. To reduce the burden of OPC and enhance HIV care outcomes, early diagnosis, better oral hygiene practices and targeted interventions addressing these risk factors–particularly smoking and alcohol consumption–are essential for this population.