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Background  Progressive cell-mediated immunodeficiency with decrease of CD4+ lymphocyte count to less than or equal to 200 cells/mm 3  is a major risk factor for colonization with  Candida  species and development of candidiasis. Oropharyngeal candidiasis may occur in up to 90% of human immunodeficiency virus (HIV)-infected patients during the course of the disease. This study is to determine the effect of prolonged highly active antiretroviral therapy (HAART) on oropharyngeal colonization with  Candida  species and oral candidiasis.    Methods  A prospective, longitudinal follow-up study in HIV-infected patients receiving HAART.    Results  The mean CD4+ count increased from 232.5 to 316 cells/mm 3  and the proportion of patients whose CD4+ count less than 200 cells/mm 3  decreased from 50.0% to 28.9% ( p  = 0.0003) in patients receiving HAART for at least 2 years. The prevalence of oral candidiasis decreased from 10.6% to 2.1% ( p  = 0.004). The decrease in  Candida  colonization was less impressive, falling from 57.8% to 46.5 % ( p  = 0.06). Of the 142 patients enrolled in at least two surveys, 48 (33.8%) remained colonized with  Candida  and 42 (29.6%) remained negative. In the remaining 52 patients, 34 switched from culture positive to negative, and an increase in CD4+ lymphocytes was noted in 91.2% of them. Among the 18 patients who switched from culture negative to positive, 61.1% also demonstrated an increase in CD4+ lymphocyte count ( p  = 0.01).    Conclusion  These findings indicate that HAART is highly effective in decreasing oral candidiasis in association with a rise in CD4+ lymphocyte counts, but only marginally effective in eliminating  Candida  from the oropharynx.

Effect of prolonged HAART on oral colonization with Candidaand candidiasis