Fungal Isolation in HIV Patients and CD4 Count

Aims: This study aimed to investigate fungal isolation in HIV infected patients and its relationship with CD4 count.

Study Design: Cross-sectional study.

Place and Duration of Study: This study was carried out in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria (between March and July 2013).

Methodology: A total of 100 positive Human Immunodeficiency Virus (HIV) patients (28 males, 72 females; age range 1-70 years) were included in this study. The sputum specimens were tested for mycobacteria using Ziehl Neelson’s staining technique. Fungal sputum culture was carried out using standard conventional fungal culture method. Identification was done using chromogenic media and standard staining methods.

Results: There were significant fungal associations with gender, age and antiretroviral therapy (P≤0.05). Out of 100 sputum samples cultured, 80 had fungal growths; 61 single and19 mixed isolates, while the remaining 20 samples were without fungal growth. Different fungi species were isolated from 5 out of the 9 patients positive for Mycobacterium spp. A total of 8 different fungal species were isolated with Candida albicans, 24(30%), as the predominant species which had a CD4 count range of 10-200 cells/µl, while Aspergillus niveus was the least, 1(1.2%) with CD4 count range of 300-400 cells/µl. Penicillium marneiffei was the second most prevalent fungi, 11(13.8%). Patients with CD4 T-cell count of less than 100 cells/µl had the highest frequency of fungal isolates from sputum 27(76.4 %) (P≤0.05), while those with CD4 counts >400 cells/µl showed no fungal infection. Patients with Aspergillus fumigatus, Candida glabrata and mixed infections had a total white blood cell (WBC) count of <4.0x109 cells /1. Neutropenia was also observed in patients with Candida albicans, Aspergillus fumigatus, Aspergillus niger and Pencillium marneiffei.

Conclusion: HIV infection increases the susceptibility to fungal colonization and infection. The CD4 counts of the patients have a strong relationship with the frequency and type of fungal isolates. The lower the CD4 count the higher the frequency of fungal isolates. Since invasive fungal colonization of the lungs remain important causes of death in immunocompromised patients, early isolation and identification of the colonizing fungi can improve the prognosis of patients.