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/<mu>L, 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.