What causes whitish plaques in Acquired Immune Deficiency Syndrome (AIDS)?

From the Guidelines

Whitish plaques in AIDS patients are caused by oral candidiasis, a fungal infection caused by Candida species, as described in the 2012 ESCMID guideline for the diagnosis and management of Candida diseases 1. The clinical manifestations of oral candidiasis in AIDS patients can vary, but the pseudomembranous form, characterized by creamy white, plaque-like lesions, is predictive of progressive immunodeficiency 1. Some key points to consider include:

• The whitish plaques can occur on the buccal or oropharyngeal mucosa or tongue surface, and can be similar to those observed in oesophageal candidiasis, with retrosternal burning pain, altered taste, and odynophagia 1.
• The plaques can progress to superficial ulceration of the mucosa, with central or surface whitish exudates, and relapse is common, often associated with recurrence of intense pain and weight loss due to poor nutrition 1.
• Treatment typically involves antifungal medications, and good oral hygiene and avoiding smoking can help prevent recurrences.
• Oral candidiasis is particularly common when CD4 counts fall below 200 cells/mm³, and its presence often signals advancing immunosuppression in AIDS patients.

From the Research

Causes of Whitish Plaques in AIDS

• Whitish plaques in AIDS patients are caused by oral candidiasis, a fungal infection 2, 3, 4, 5, 6
• Oral candidiasis is a common opportunistic infection in individuals with HIV/AIDS, affecting over 90% of patients with AIDS 3, 5
• The infection is characterized by the presence of whitish plaques on the oral mucosa, which can be painful and difficult to treat 2, 4

Risk Factors for Oral Candidiasis in AIDS

• Immunodeficiency is a major risk factor for the development of oral candidiasis in AIDS patients 3, 5
• The degree of immunosuppression is directly related to the risk of clinical relapse of oral candidiasis 3, 5
• Other risk factors include the use of antibiotics, corticosteroids, and other immunosuppressive medications 2

Treatment Options for Oral Candidiasis in AIDS

• Antifungal medications, such as fluconazole, itraconazole, and nystatin, are commonly used to treat oral candidiasis in AIDS patients 2, 3, 4, 5, 6
• Fluconazole is a highly effective treatment option, with a cure rate of 82% in one study 2
• Other treatment options, such as clotrimazole and ketoconazole, may also be effective, but may have a higher risk of clinical relapse 3, 5