Oral Candidiasis as a Predictor of TB in HIV Outpatients

Introduction: TB is the most common cause of mortality in HIV disease. TB and oral candidiasis (OC) are the first and second most frequent presentations of AIDS. However TB diagnosis is a challenge in most of the developing world. This cross sectional study explored the association between these two HIV co-morbidities with a view to predicting TB and instituting appropriate diagnosis and management. Methods:A random sample of 101 patients was selected from HIV+ outpatients attending the Mbagathi District Hospital outpatient clinic in Nairobi Kenya. Clinical and sociodemographic data were captured by a questionnaire followed by a clinical examination of the head, neck and mouth. Results:The gender distribution of the study patients was 62% females and 38% males. Opportunistic infections seen on presentation included TB (57.4%) and OC (72%).The crude odds ratio for TB in the presence of OC was 4.0 (95% CI = 1.3 – 12.0).When adjusting for the use of antiretrovirals, the Maentel Haenszel Odds Ratio with ARV treatment was 5.72 (95% CI = 1..69 -23.0) p= 0.002.The Maentel Haenszel Odds Ratio without ARVs was 2.60 (95% CI = 0.08 - 234.5) p= 1.0..The Maentel –Haenszel chi square test for heterogeneity was 5.7 (95% CI = 1.2 – 28) p = 0.001 Conclusions:There is a more than two fold decrease in the Odds ratio of TB in OPC by using ARVs. Thus ARV use is an effect modifier on the risk of TB in OC with a significant lowering of the risk of TB. Further studies in Kenya on both in and out patients are required. This evidence suggests that it is prudent to investigate for TB in the presence of OPC and commence treatment for both conditions with/without ARVs. Combined antifungal , anti TB and ARV treatment protocols should be developed.