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      Factors Associated with Esophageal Candidiasis and Its Endoscopic Severity in the Era of Antiretroviral Therapy

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          Abstract

          Background

          Candidia esophagitis (CE) is an AIDS-defining condition, usually occurring in individuals with low CD4 counts of <200 cells/µL. Endoscopy is a valuable definitive diagnostic method for CE but may not be indicated for asymptomatic patients or for those with high CD4 counts or without oral candidiasis. This study assessed such patients to clarify the factors associated with CE and its severity on endoscopy in the highly active antiretroviral therapy (HAART) era.

          Methodology/ Principal Findings

          A total of 733 HIV-infected patients who underwent upper gastrointestinal (GI) endoscopy were analyzed. Sexual behavior, CD4 + count, HIV-RNA viral load (VL), history of HAART, GI symptoms, GI diseases, and oral candidiasis were assessed. Endoscopic severity of CE was classified as mild (Kodsi's grade I/II) or severe (grade III/IV). Of the 733 subjects, 62 (8.46%) were diagnosed with CE (mild, n = 33; severe, n = 29). Of them, 56.5% (35/62) had no GI symptoms, 30.6% (19/62) had CD4 + ≥200 cells/μL, and 55.3% (21/38) had no oral candidiasis. Univariate analysis found lower CD4+ counts, higher HIV VL, and no history of HAART to be significantly associated with CE. With lower CD4 + counts and higher HIV VL, CE occurrence increased significantly ( P<0.01 for trend in odds). Multivariate analysis showed low CD4+ counts and high HIV VL to be independently associated with CE. Of the severe CE patients, 55.2% (16/29) had no GI symptoms and 44.4% (8/18) had no oral candidiasis. Median CD4 + counts in severe cases were significantly lower than in mild cases (27 vs. 80; P = 0.04).

          Conclusions

          Low CD4+ counts and high HIV VL were found to be factors associated with CE, and advanced immunosuppression was associated with the development of severity. Endoscopy is useful as it can detect CE, even severe CE, in patients without GI symptoms, those with high CD4 counts, and those without oral candidiasis.

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          Author and article information

          Contributors
          Role: Editor
          Journal
          PLoS One
          PLoS ONE
          plos
          plosone
          PLoS ONE
          Public Library of Science (San Francisco, USA )
          1932-6203
          2013
          26 March 2013
          : 8
          : 3
          : e58217
          Affiliations
          [1 ]Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan
          [2 ]Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
          [3 ]Department of Clinical Research and Informatics, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
          [4 ]Department of Infectious Disease, National Center for Global Health and Medicine, Tokyo, Japan
          [5 ]Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
          Institut National de la Santé et de la Recherche Médicale, France
          Author notes

          Competing Interests: The authors have declared that no competing interests exist.

          Advised to the writing of the manuscript: JA NO SO NU. Conceived and designed the experiments: NN SN NO. Performed the experiments: NN SN NA. Analyzed the data: TS. Contributed reagents/materials/analysis tools: HY NA. Wrote the paper: SN NN.

          Article
          PONE-D-12-27034
          10.1371/journal.pone.0058217
          3608638
          23555571
          bb4826ca-3104-4bf9-bf4e-2cfa1b9b4ac0
          Copyright @ 2013

          This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

          History
          : 4 September 2012
          : 1 February 2013
          Page count
          Pages: 6
          Funding
          This study was partly supported by Medicine for Ministry of Health, Labour and Welfare, Health and Labour Sciences Research Grants, Research on Clinical Trials' Infrastructure Development and grants for research and development in National Center for Global Health and Medicine. No additional external funding was received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
          Categories
          Research Article
          Medicine
          Gastroenterology and Hepatology
          Endoscopy
          Esophagus
          Gastrointestinal Infections
          Infectious Diseases
          Fungal Diseases
          Mycosis
          Sexually Transmitted Diseases
          Candidiasis
          Viral Diseases
          HIV
          HIV opportunistic infections
          Gastrointestinal Infections
          Obstetrics and Gynecology
          Genitourinary Infections
          Candidiasis
          Urology
          Genitourinary Infections
          Candidiasis

          Uncategorized
          Uncategorized

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