Journal of HIV for Clinical and Scientific Research
Short Communication
Pseudomembranous Candidiasis Indicates High Level Drug Resistance among Patients on Antiretroviral Treatment in Nairobi East District, Kenya
Objectives: The aim of this study was to determine antiretroviral drug
resistance patterns in patients on long-term antiretroviral therapy presenting
with OPC.
Methods: An exploratory survey was performed among HIV-infected patients on
ART for minimum of 24 months presenting with OPC in Nairobi, Kenya. Type
(pseudomembraneous or erythematous candidiasis, angular cheilitis) and previous
episodes of OPC, CD4-cell counts, duration, regimen and adherence on ART were
compared between patients with high (>1000copies/ml) and low HIV-RNA levels. Genotypic resistance testing
was performed on those with high viral loads.
Results: Out of (n=45) patients with OPC, (n=28; 62%) had high HIV-RNA
levels. The (n=28) patients who mostly presented with pseudomembraneuos
candidiasis (n=26; p<.0001), had significantly more previous episodes of OPC (55% versus
18%; P<0.0373) lower median CD4 cell counts (74 versus 521; P<.0001) and higher
HIV-RNA median plasma levels (111,191 copies/ml versus <20; P<.0001). The sensitivity
(0.96) and specificity (0.87) of pseudomebraneous candidiasis to predict
virological failure was high.
HIV genotyping performed in 22 of the 28
patients showed that most (18/22) had drug resistance mutations of which 12/18
had Lamivudine-associated M184V mutation, 14/18 had TAMS and 16/18 had NNRTI
mutations. One patient had major PI mutations.
Conclusion: Virological failure and
drug resistance mutations including TAMs should be suspected in patients on
long-term ART that present with pseudomembraneous candidiasis. We propose to
include recurrent OPC in the WHO clinical criteria for ART failure as well as
to establish clinical training sessions to build competences among health care
providers.
http://www.peertechz.com/HIV-Clinical-Scientific-Research/pdf/JHCSR-2-112.pdf
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