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ABSTRACT
Oral candidiasis (OC) is the most common opportunistic fungal infection among immunocompromised individuals. This systematic review and meta-analysis reports on the contribution of non-albicans Candida species in causing OC among human immunodeficiency virus (HIV)-infected individuals in sub-Saharan Africa between 2005 and 2015. Thirteen original research articles on oral Candida infection/colonization among HIV-infected African populations were reviewed. The prevalence of OC ranged from 7.6% to 75.3%. Pseudomembranous candidiasis was found to range from 12.1% to 66.7%. The prevalence of non-albicans Candida species causing OC was 33.5% [95% confidence interval (CI) 30.9-36.39%]. Of 458 nonalbicans Candida species detected, C. glabrata (23.8%; 109/458) was the most common, followed by C. tropicalis (22%; 101/458) and C. krusei (10.7%; 49/458). The overall fluconazole resistance was 39.3% (95% CI 34.4-44.1%). Candida albicans was significantly more resistant than non-albicans Candida species to fluconazole (44.7% vs 21.9%; p < 0.001). One-quarter of the cases of OC among HIV-infected individuals in sub-Saharan Africa were due to nonalbicans Candida species. Candida albicans isolates were more resistant than the non-albicans Candida species to fluconazole and voriconazole. Strengthening the capacity for fungal diagnosis and antifungal susceptibility testing in sub-Saharan Africa is mandatory in order to track the azole resistance trend.
ARTICLE HISTORY
Received 26 January 2017
Accepted 4 April 2017
KEYWORDS
Oral candidiasis; Candida colonization; HIV infection; non-albicans Candida species; fluconazole resistance; sub-Saharan Africa
Introduction
Oral candidiasis (OC) is one of the most common fungal opportunistic infections in immunocompromised individuals [1]. OC occurs in up to 95% of human immunodeficiency virus (HIV)-infected individuals during the course of their illness [2,3], and is a prognostic indicator for acquired immune deficiency syndrome (AIDS) [4,5]. In sub-Saharan Africa, there is an increased prevalence of severe immunocompromised conditions, which is associated with a higher incidence of opportunistic infections [6]. Worldwide, it is estimated that 70% of the HIVinfected individuals living in sub-Saharan Africa [6] are at risk of infection with OC.
OC is mainly caused by Candida albicans [7], which accounts for up to 81% of cases among HIV-infected individuals [8]. It is documented that between 17% and 75% of healthy individuals can be colonized by Candida species [9,10]. However, non-albicans Candida species have been implicated in colonization of the oral cavity, eventually causing infection in 20-40% of immunocompromised...