The relationship between opportunistic pulmonary fungal infections and CD4 count levels among HIV-seropositive patients in Calabar, Nigeria

Background: Most HIV-seropositive people who develop AIDS die from an opportunistic infection, such as pulmonary mycosis, rather than the HIV infection itself. Data on the pattern of respiratory mycoses and the immunological profile of HIV-seropositive patients in Nigeria are scarce and uncoordinated, so we investigated respiratory mycosis and CD4 count among HIV-seropositive and AIDS patients attending the antiretroviral clinics at the University of Calabar Teaching Hospital and Lawrence Henshaw Hospital in Calabar, Nigeria. Method: From May 2009 to July 2010 we carried out a prospective study of 331 individuals with respiratory symptoms, of whom 272 were HIV seropositive, aged 17-75 years and able to produce sputum and 59 were HIV non-reactive. Relevant samples were collected and subjected to direct microscopy, fungal culture and serology. Results: The overall prevalence of pulmonary mycoses was 36.0%, the most prevalent fungal pathogen being Candida albicans (11.8%). Pneumocystis jirovecii (7.4%) was confirmed as an important opportunistic fungal agent in HIV-infected individuals in Calabar. Patients aged 25-34 years were at the highest risk of pulmonary mycosis (43.9%). HIV-positive patients with mycoses had lower mean CD4 counts (142.3 +/- 100.1 cells mu l(-1)) than those without mycoses (435.4 +/- 249.1 cells mu l(-1) ) (t = 10.5, p = 0.00). Conclusion: Opportunistic pulmonary infections arise more frequently in HIV patients with lower CD4 counts. A more detailed comparative study with other opportunistic infections may help formalize the use of CD4 count as an indicator of HIV/AIDS with opportunistic mycoses.