HIV and Oral Thrush: Uncovering the Link
Oral thrush is a common fungal infection that affects the mouth and throat, and in some cases, the esophagus. While it is strongly associated with HIV due to the immune system weakening caused by the virus, it can also occur in individuals without HIV.
HIV weakens the immune system, making it harder for the body to fight infections. This weakened state allows the yeast Candida, which is present throughout the body and thrives in moist environments like the mouth, to overgrow. Candida albicans is the yeast responsible for oral thrush, leading to creamy white or yellow patches on the tongue and inside the mouth. These patches can cause pain or discomfort [1][2].
In people with HIV, oral thrush is a common indicator of weakened immunity. It often occurs in the first stage of an HIV infection, when CD4 cell counts drop to 350 colony-forming units per milliliter (CFU/mL). In more advanced stages, a CD4 cell count of 200 CFU/mL or less may cause oral thrush to affect the esophagus.
However, oral thrush can also occur in individuals without HIV. Causes besides HIV-related immunosuppression include other types of immunosuppression (e.g., chemotherapy, organ transplantation), use of antibiotics disrupting normal flora, diabetes, dry mouth or radiation therapy, increased stress, and other health conditions weakening immune defenses [3][4].
Combination antiretroviral treatment helps support the immune system in people with HIV and may reduce the likelihood of developing certain mouth conditions. In people without HIV, practicing good oral hygiene, including using a soft toothbrush, cleaning between the teeth, using an antiseptic mouthwash, attending routine dentist check-ups, and drinking plenty of fluids throughout the day, may help prevent oral thrush. If wearing dentures, cleaning them regularly and ensuring that they fit correctly may also help prevent oral thrush [5].
Symptoms of oral thrush in the mouth, throat, and esophagus may include white patches, soreness or redness, dryness or cotton-like sensation, pain or difficulty eating or swallowing, loss of taste, and cracked corners of the mouth. In people with HIV, oral thrush can be one of the most common infections. Other conditions that weaken the immune system may also cause oral thrush, including metabolic disorders, radiation therapy, organ transplantation, long-term use of steroids, salivary gland hypofunction, and malnutrition [6].
Antimycotics, such as fluconazole, are antifungal medications that can help stop the growth of fungal infections such as oral thrush. However, these medications may cause side effects such as headache, nausea, stomach ache, and fungal resistance [7].
Factors such as age, oral hygiene, sexual behaviors, and lifestyle may play a role in the development of oral thrush, either with or without HIV present. While oral thrush is a common indicator of weakened immunity such as in HIV, it is not exclusive to HIV and can occur in many other health contexts.
- HIV, by weakening the immune system, allows Candida to overgrow and cause oral thrush in individuals with HIV.
- Oral thrush, caused by the yeast Candida albicans, can be a common indicator of weakened immunity in people with HIV.
- In people without HIV, lifestyle factors such as poor oral hygiene, extended use of antibiotics, and even chronic diseases like diabetes can contribute to the development of oral thrush.
- Maintaining good oral health and wellness practices, including dental check-ups, proper denture hygiene, and using antiseptic mouthwash, may help prevent oral thrush in individuals without HIV.
- Oral thrush can manifest as various symptoms, such as white patches, soreness, and difficulty eating or swallowing, and it may be associated with a weakened immune system due to conditions other than HIV, such as metabolic disorders or long-term use of steroids.
