Is erythematous candidiasis associated with advanced HIV disease?

Objectives: A multicentre collaborative study by the London HIV and Dentistry Group failed to associate the presence of erythematous candidiasis (EC) with advanced HIV disease. Data from a study of the periodontal health of homosexual men attending a genito-urinary medicine clinic presented an opportunity to investigate social and medical factors related to the presence of EC and mucosal disease.

Subjects And Methods: 312 men with HIV were examined by a single examiner blinded to HIV status; 22.8% had an indicator condition for AIDS; 37.8% had CD4 lymphocyte counts less than 200 cells mm-3; and 53.8% met the 1993 case definition for AIDS; 59.6% of the men with HIV had oral manifestations of the infection. The most common were: oral hairy leukoplakia, 44.2%; EC, 26.9%; and pseudomembranous candidiasis (PC), 11.5%.

Results: Advanced HIV disease was a less powerful predictor of EC than PC. Advanced HIV disease also predicted the presence of hairy leukoplakia and mucosal ulceration. EC was strongly associated with tobacco use.

Conclusions: While methodological differences explain some variation with previous research, these data also suggest that EC and PC may not carry the same prognostic significance and longitudinal studies are required to confirm these findings.