Association between Oral Candidiasis and Low CD4 Cell Count in HIV-positive Patients in Libreville, Gabon
C. Manomba Boulingui, R. Siby Matotou, C. Mayandza, R. Moutongo Mouandza, A. T. Mounombi, D. Moussavou Mabicka, J. C. Mihindou, M. Ntsame Owono, M. Essomeyo Ngue Mebale, S. Nzenze Afene, D. P. Mawili Mboumba, M. K. Bouyou Akotet
International Journal of TROPICAL DISEASE & Health · pp. 47–55 · Published 7 May 2026
10.9734/ijtdh/2026/v47i41740Abstract
Background: Oral candidiasis (OPC) is one of the most common opportunistic infections in people living with HIV (PLHIV), however, it remains under-documented in sub-Saharan Africa. Aims: This study aims to assess the association between OPC and CD4 cell count in HIV-positive patients in Libreville, Gabon. Place and Duration of Study: The study was conducted at Infectiology Unit, Centre Hospitalier Universitaire de Libreville (CHUL), between April to October 2021. Methodology: A prospective cross-sectional study was conducted from April to October 2021 at the Centre Hospitalier Universitaire de Libreville (CHUL). PLHIV aged ≥18 years with clinical suspicion of OPC were enrolled. Oral samples were cultured on CHROMagar™ Candida for species identification. Statistical analyses used Fisher's exact test, Student's t-test, and the Mann–Whitney U test (significance threshold: p<0.05). Results: Of 255 PLHIV enrolled, 205 (80.0%) had confirmed OPC. The majority were female (72.5%). Six Candida species were identified from 239 isolates; C. albicans was most frequent (55.2%), followed by C. krusei (21.8%), C. dubliniensis (10.5%), C. glabrata (9.2%), C. tropicalis (2.1%), and C. parapsilosis (1.2%). The most common clinical forms were pseudomembranous candidiasis (74.4%; n=191), angular cheilitis (63.3%; n=161), and erythematous candidiasis (53.3%; n=136). OPC prevalence was highest in WHO stage III patients (89.3%; 84/94) and in those with CD4 cell counts <200 cells/mm³ (64.4%; n=114); this association was statistically significant (p=0.03). Conclusion: C. albicans remains the dominant causative species of OPC among PLHIV in Libreville, although non-albicans Candida (NAC) species also contribute substantially. OPC is significantly more prevalent in patients with advanced HIV disease (WHO stages III–IV) and CD4+ counts <200 cells/µL. Antifungal susceptibility testing should be incorporated into routine diagnostic practice.
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