Role of oral candidiasis in TB and HIV co-infection: AIDS Clinical Trial Group Protocol A5253

C. H. Shiboski, H. Chen, M. A. Ghannoum, L. Komarow, S. Evans, P. K. Mukherjee, N. Isham, D. Katzenstein, A. Asmelash, A. E. Omozoarhe, S. Gengiah, R. Allen, S. Tripathy, Susan Swindells

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the association between oral candidiasis and tuberculosis (TB) in human immunodeficiency virus (HIV) infected individuals in sub-Saharan Africa, and to investigate oral candidiasis as a potential tool for TB case finding. METHODS: Protocol A5253 was a cross-sectional study designed to improve the diagnosis of pulmonary TB in HIV-infected adults in high TB prevalence countries. Participants received an oral examination to detect oral candidiasis. We estimated the association between TB disease and oral candidiasis using logistic regression, and sensitivity, specificity and predictive values. RESULTS: Of 454 participants with TB culture results enrolled in African sites, the median age was 33 years, 71% were female and the median CD4 count was 257 cells/ mm 3. Fifty-four (12%) had TB disease; the prevalence of oral candidiasis was significantly higher among TB cases (35%) than among non-TB cases (16%, P < 0.001). The odds of having TB was 2.4 times higher among those with oral candidiasis when controlling for CD4 count and antifungals (95%CI 1.2-4.7, P = 0.01). The sensitivity of oral candidiasis as a predictor of TB was 35% (95%CI 22-48) and the specificity 85% (95%CI 81-88). CONCLUSION: We found a strong association between oral candidiasis and TB disease, independent of CD4 count, suggesting that in resource-limited settings, oral candidiasis may provide clinical evidence for increased risk of TB and contribute to TB case finding.

Original languageEnglish (US)
Pages (from-to)682-688+i
JournalInternational Journal of Tuberculosis and Lung Disease
Volume18
Issue number6
DOIs
StatePublished - Jun 1 2014

Fingerprint

Oral Candidiasis
Virus Diseases
Clinical Protocols
Coinfection
Acquired Immunodeficiency Syndrome
Tuberculosis
Clinical Trials
HIV
Oral Tuberculosis
CD4 Lymphocyte Count
Oral Diagnosis
Africa South of the Sahara
Pulmonary Tuberculosis
Cross-Sectional Studies
Logistic Models

Keywords

  • Acquired immune-deficiency syndrome
  • HIV
  • Oral candidiasis
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

Cite this

Role of oral candidiasis in TB and HIV co-infection : AIDS Clinical Trial Group Protocol A5253. / Shiboski, C. H.; Chen, H.; Ghannoum, M. A.; Komarow, L.; Evans, S.; Mukherjee, P. K.; Isham, N.; Katzenstein, D.; Asmelash, A.; Omozoarhe, A. E.; Gengiah, S.; Allen, R.; Tripathy, S.; Swindells, Susan.

In: International Journal of Tuberculosis and Lung Disease, Vol. 18, No. 6, 01.06.2014, p. 682-688+i.

Research output: Contribution to journalArticle

Shiboski, CH, Chen, H, Ghannoum, MA, Komarow, L, Evans, S, Mukherjee, PK, Isham, N, Katzenstein, D, Asmelash, A, Omozoarhe, AE, Gengiah, S, Allen, R, Tripathy, S & Swindells, S 2014, 'Role of oral candidiasis in TB and HIV co-infection: AIDS Clinical Trial Group Protocol A5253', International Journal of Tuberculosis and Lung Disease, vol. 18, no. 6, pp. 682-688+i. https://doi.org/10.5588/ijtld.13.0729
Shiboski, C. H. ; Chen, H. ; Ghannoum, M. A. ; Komarow, L. ; Evans, S. ; Mukherjee, P. K. ; Isham, N. ; Katzenstein, D. ; Asmelash, A. ; Omozoarhe, A. E. ; Gengiah, S. ; Allen, R. ; Tripathy, S. ; Swindells, Susan. / Role of oral candidiasis in TB and HIV co-infection : AIDS Clinical Trial Group Protocol A5253. In: International Journal of Tuberculosis and Lung Disease. 2014 ; Vol. 18, No. 6. pp. 682-688+i.
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T1 - Role of oral candidiasis in TB and HIV co-infection

T2 - AIDS Clinical Trial Group Protocol A5253

AU - Shiboski, C. H.

AU - Chen, H.

AU - Ghannoum, M. A.

AU - Komarow, L.

AU - Evans, S.

AU - Mukherjee, P. K.

AU - Isham, N.

AU - Katzenstein, D.

AU - Asmelash, A.

AU - Omozoarhe, A. E.

AU - Gengiah, S.

AU - Allen, R.

AU - Tripathy, S.

AU - Swindells, Susan

PY - 2014/6/1

Y1 - 2014/6/1

N2 - OBJECTIVE: To evaluate the association between oral candidiasis and tuberculosis (TB) in human immunodeficiency virus (HIV) infected individuals in sub-Saharan Africa, and to investigate oral candidiasis as a potential tool for TB case finding. METHODS: Protocol A5253 was a cross-sectional study designed to improve the diagnosis of pulmonary TB in HIV-infected adults in high TB prevalence countries. Participants received an oral examination to detect oral candidiasis. We estimated the association between TB disease and oral candidiasis using logistic regression, and sensitivity, specificity and predictive values. RESULTS: Of 454 participants with TB culture results enrolled in African sites, the median age was 33 years, 71% were female and the median CD4 count was 257 cells/ mm 3. Fifty-four (12%) had TB disease; the prevalence of oral candidiasis was significantly higher among TB cases (35%) than among non-TB cases (16%, P < 0.001). The odds of having TB was 2.4 times higher among those with oral candidiasis when controlling for CD4 count and antifungals (95%CI 1.2-4.7, P = 0.01). The sensitivity of oral candidiasis as a predictor of TB was 35% (95%CI 22-48) and the specificity 85% (95%CI 81-88). CONCLUSION: We found a strong association between oral candidiasis and TB disease, independent of CD4 count, suggesting that in resource-limited settings, oral candidiasis may provide clinical evidence for increased risk of TB and contribute to TB case finding.

AB - OBJECTIVE: To evaluate the association between oral candidiasis and tuberculosis (TB) in human immunodeficiency virus (HIV) infected individuals in sub-Saharan Africa, and to investigate oral candidiasis as a potential tool for TB case finding. METHODS: Protocol A5253 was a cross-sectional study designed to improve the diagnosis of pulmonary TB in HIV-infected adults in high TB prevalence countries. Participants received an oral examination to detect oral candidiasis. We estimated the association between TB disease and oral candidiasis using logistic regression, and sensitivity, specificity and predictive values. RESULTS: Of 454 participants with TB culture results enrolled in African sites, the median age was 33 years, 71% were female and the median CD4 count was 257 cells/ mm 3. Fifty-four (12%) had TB disease; the prevalence of oral candidiasis was significantly higher among TB cases (35%) than among non-TB cases (16%, P < 0.001). The odds of having TB was 2.4 times higher among those with oral candidiasis when controlling for CD4 count and antifungals (95%CI 1.2-4.7, P = 0.01). The sensitivity of oral candidiasis as a predictor of TB was 35% (95%CI 22-48) and the specificity 85% (95%CI 81-88). CONCLUSION: We found a strong association between oral candidiasis and TB disease, independent of CD4 count, suggesting that in resource-limited settings, oral candidiasis may provide clinical evidence for increased risk of TB and contribute to TB case finding.

KW - Acquired immune-deficiency syndrome

KW - HIV

KW - Oral candidiasis

KW - Tuberculosis

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