Candida-Specific Systemic Cell-Mediated Immune Reactivities in Human Immunodeficiency Virus—Positive Persons with Mucosal Candidiasis

Oropharyngeal candidiasis (OPC), as opposed to vulvovaginal candidiasis (VVC), is a common opportunistic infection in human immunodeficiency virus (HIV)‐positive persons that correlates with reduced CD4 T cell counts. Although cell-mediated immunity (CMI) by CD4 Th1-type cells is considered to be the predominant host defense against mucosal candidiasis, the immune factors associated with susceptibility to OPC in HIV-positive persons are not well understood. This study investigated Candida-specific systemic CMI in HIV-positive persons with OPC and/or VVC. Reductions in delayed skin test reactivity to Candida antigen were observed in HIV-positive persons with CD4 cell counts !200 cells/mL, irrespective of the presence of mucosal infection. Likewise, despite the correlate of OPC with reduced CD4 cell counts in HIV-positive persons, differences in Candida-specific peripheral blood mononuclear cell proliferation and Th1/Th2 cytokine production between HIV-positive and HIV-negative persons were not consistent in a manner to suggest that deficiencies in Candida-specific systemic CMI account solely for the susceptibility to OPC. Mucosal candidiasis, especially oropharyngeal, is a common opportunistic infection in human immunodeficiency virus (HIV)‐positive persons and frequency correlates with reduced CD4 cell counts [1‐5]. In fact, in the era before highly active antiretroviral therapy (HAART), »95% of HIV-positive persons experienced an episode of oropharyngeal candidiasis (OPC) sometime during progression to AIDS [3, 6]. In the postHAART era, although the incidence of OPC has declined, OPC continues to be a significant problem [7‐10]. Although previous studies similarly suggested an increased prevalence of vulvovaginal candidiasis (VVC) in HIV-positive women [11‐13], more recent, case-controlled studies show that the incidence of symptomatic VVC is not significantly higher in HIV-positive women, compared with HIV-negative women who are at risk for exposure to HIV [14‐16]. Furthermore, in contrast to OPC,