Changes in Oropharyngeal Colonization and Infection byCandida albicansin Human Immunodeficiency Virus–Infected Patients

Gottfredsson et al. [1] showed that oropharyngeal colonization by Candida species was strongly associated with plasma human immunodeficiency virus type 1 (HIV-1) RNA and suggested that this probably was due to the suppression of local mucosal immune responses. Klein et al. [2] commented on the report by Gottfredsson et al. [1], pointing out that HIV-1 replication might have a direct effect on the virulence of Candida species and that HIV-1 protease inhibitors (PIs) also might play an important role in colonization of Candida species. In 1992, we evaluated the prevalence of oropharyngeal colonization and infection by Candida albicans in a cohort of 200 HIV-infected persons, by culturing oral swab samples [3]. In January 2000, we once again examined this group of patients: 92 had died, 29 had moved or could not be located, and 9 were excluded (7 because they had been using a new combination of antiretrovirals for <3 months and 2 because they were receiving long-term antifungal prophylaxis for cryptococcosis). We examined the 70 remaining patients, applying both clinical and mycologic criteria, to establish the definitive diagnosis of oral candidiasis. Consequently, we carried out a time-cohort analysis, comparing the frequency of oropharyngeal colonization and infection by C. albicans in these 70 patients in 1992 and 2000 (table 1).