HIV+ Patients Harbor Yeast Species in Deep Periodontal Lesions

Objective: HIV-infected individulals are predisposed to advanced oral diseases, such as oropharyngeal candidiasis and periodontal diseases. The involvement of C. albicans and other fungal species in oral mucocutaneous infections is well established, however, the role that fungal species may play in the progress of periodontal lesions remains unclear and uninvestigated. The purpose of this study was to investigate yeast species in oral subgingival sites from an HIV+ population with periodontal disease, in comparison to a group of non-HIV+ individuals with comparable oral conditions. Methods: Eighty HIV+ and 40 non-HIV+ patients with periodontal lesions were screened and a complete oral health evaluation was performed on each patient including HIV viral load and CD4 counts. In addition to subgingival samples, oral swabs of the tongue and buccal mucosa were collected from all patients and cultured on selective media for fungus. Fungal species were identified using standard mycology protocols in addition to the CoAg assay with Fusobacterium nucleatum. Results: Sixty two (77.5%) of the 80 patients tested positive for oral yeast cultures, of these 46 (74%) were positive in subgingival cultures. Candida albicans was the species most frequently recovered from oral sites, however, 29 (47%) patients were found to be harboring C. dubliniensis, six of which showed signs of oral candidiasis. In contrast, among the 40 non-HIV+ group, only three patients had a positive subgingival culture with light fungal growth. Conclusion: The significant recovery of yeast from HIV+ subgingival periodontal lesions supports the need for further investigations into the role that fungus may play in the progression of periodontal and other soft tissue diseases in these critically ill patients, as well as whether fungus in such oral sites contributes to morbidity during HIV disease progression. Questions regarding host variables predisposing these sites to colonization must be investigated. Supported by NIH, DE14424 and DE00464.