Type of infection

Candida is a fungal yeast infection that frequently affects the mouth and throat (oral candida), gullet (oesophageal candida), sinuses, genital organs and – rarely – the brain.

Candida is also called thrush and it is very common in people with CD4 counts under 300 cells/mm³, and it becomes more common the lower the CD4 count.

Main symptoms

• Oral thrush appears as white or red patches (especially in the mouth) that can sometimes be scraped off, and can include cracks at the corners of the mouth.
• In the sinuses it can cause headaches, difficulty breathing and a build up of mucus.
• In the gullet it can make eating difficult and result in vomiting.

Diagnosis

Visual examination for oral candida, swap sample for candida in other areas.

Treatment

• Diet changes – cutting down on foods that contain refined sugars and wheat.
• Live, unpasteurised yoghurt that contains lactobacillus bacteria can help – eaten or applied directly to the vagina.
• Anti-fungal medications: co-trimoxazole lozenges, nystatin or itraconazole syrup, fluconazole oral solution, miconazole patch (for the inside of the mouth), ketaconazole, fluconazole and itraconazole tablets (fluconazole may be better if using rifampicin for TB treatment).

If CD4 counts increase in response to ARVs, candida should occur less often – and can stop completely.

Prophylaxis

Drugs are rarely used for prophylaxis in people who may get candida but with no symptoms because the risks of side effects and developing resistance usually outweigh the benefits of protection.

Research

There are several experimental treatments that may help people who develop resistance to existing anti-fungals.

Other skin problems

Minor skin problems can be one of the first symptoms of HIV and are an indication that CD4 count is less than 300 cells/mm³.

Often these are relatively minor, like dry skin. But they can also be from an infection that your immune system is no longer strong enough to fight.