Association between Oral Candidiasis and Low CD4 Cell Count in HIV-positive Patients in Libreville, Gabon
C. Manomba Boulingui *
Centre de recherche en Pathogènes Infectieux et Pathologies Associées, CREIPA, Université des Sciences de la Santé, Owendo, Gabon, Department of Medicine, Faculty of Medicine, Université des Sciences de la Santé, Owendo, Gabon and Infectious Diseases Ward, Institut des Maladies Infectieuses Professeur Daniel Gahouma, Gabon.
R. Siby Matotou
Centre de recherche en Pathogènes Infectieux et Pathologies Associées, CREIPA, Université des Sciences de la Santé, Owendo, Gabon and Department of Parasitology Mycology, Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, Owendo, Gabon.
C. Mayandza
Centre de recherche en Pathogènes Infectieux et Pathologies Associées, CREIPA, Université des Sciences de la Santé, Owendo, Gabon and Department of Parasitology Mycology, Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, Owendo, Gabon.
R. Moutongo Mouandza
Centre de recherche en Pathogènes Infectieux et Pathologies Associées, CREIPA, Université des Sciences de la Santé, Owendo, Gabon and Department of Parasitology Mycology, Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, Owendo, Gabon.
A. T. Mounombi
Centre de recherche en Pathogènes Infectieux et Pathologies Associées, CREIPA, Université des Sciences de la Santé, Owendo, Gabon and Department of Parasitology Mycology, Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, Owendo, Gabon.
D. Moussavou Mabicka
Centre de recherche en Pathogènes Infectieux et Pathologies Associées, CREIPA, Université des Sciences de la Santé, Owendo, Gabon and Department of Parasitology Mycology, Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, Owendo, Gabon.
J. C. Mihindou
Centre de recherche en Pathogènes Infectieux et Pathologies Associées, CREIPA, Université des Sciences de la Santé, Owendo, Gabon and Department of Parasitology Mycology, Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, Owendo, Gabon.
M. Ntsame Owono
Centre de recherche en Pathogènes Infectieux et Pathologies Associées, CREIPA, Université des Sciences de la Santé, Owendo, Gabon, Department of Medicine, Faculty of Medicine, Université des Sciences de la Santé, Owendo, Gabon and Infectious Diseases Ward, Institut des Maladies Infectieuses Professeur Daniel Gahouma, Gabon.
M. Essomeyo Ngue Mebale
Centre de recherche en Pathogènes Infectieux et Pathologies Associées, CREIPA, Université des Sciences de la Santé, Owendo, Gabon and Department of Medicine, Faculty of Medicine, Université des Sciences de la Santé, Owendo, Gabon.
S. Nzenze Afene
Centre de recherche en Pathogènes Infectieux et Pathologies Associées, CREIPA, Université des Sciences de la Santé, Owendo, Gabon and Department of Parasitology Mycology, Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, Owendo, Gabon.
D. P. Mawili Mboumba
Centre de recherche en Pathogènes Infectieux et Pathologies Associées, CREIPA, Université des Sciences de la Santé, Owendo, Gabon and Department of Parasitology Mycology, Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, Owendo, Gabon.
M. K. Bouyou Akotet
Centre de recherche en Pathogènes Infectieux et Pathologies Associées, CREIPA, Université des Sciences de la Santé, Owendo, Gabon and Department of Parasitology Mycology, Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, Owendo, Gabon.
*Author to whom correspondence should be addressed.
Abstract
Background: Oral candidiasis (OPC) is one of the most common opportunistic infections in people living with HIV (PLHIV), however, it remains under-documented in sub-Saharan Africa.
Aims: This study aims to assess the association between OPC and CD4 cell count in HIV-positive patients in Libreville, Gabon.
Place and Duration of Study: The study was conducted at Infectiology Unit, Centre Hospitalier Universitaire de Libreville (CHUL), between April to October 2021.
Methodology: A prospective cross-sectional study was conducted from April to October 2021 at the Centre Hospitalier Universitaire de Libreville (CHUL). PLHIV aged ≥18 years with clinical suspicion of OPC were enrolled. Oral samples were cultured on CHROMagar™ Candida for species identification. Statistical analyses used Fisher's exact test, Student's t-test, and the Mann–Whitney U test (significance threshold: p<0.05).
Results: Of 255 PLHIV enrolled, 205 (80.0%) had confirmed OPC. The majority were female (72.5%). Six Candida species were identified from 239 isolates; C. albicans was most frequent (55.2%), followed by C. krusei (21.8%), C. dubliniensis (10.5%), C. glabrata (9.2%), C. tropicalis (2.1%), and C. parapsilosis (1.2%). The most common clinical forms were pseudomembranous candidiasis (74.4%; n=191), angular cheilitis (63.3%; n=161), and erythematous candidiasis (53.3%; n=136). OPC prevalence was highest in WHO stage III patients (89.3%; 84/94) and in those with CD4 cell counts <200 cells/mm³ (64.4%; n=114); this association was statistically significant (p=0.03).
Conclusion: C. albicans remains the dominant causative species of OPC among PLHIV in Libreville, although non-albicans Candida (NAC) species also contribute substantially. OPC is significantly more prevalent in patients with advanced HIV disease (WHO stages III–IV) and CD4+ counts <200 cells/µL. Antifungal susceptibility testing should be incorporated into routine diagnostic practice.
Keywords: Oral candidiasis, HIV, candida species, CD4 cell count, sub-Saharan Africa, Gabon, antifungal resistance.