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Clinical Microbiology Reviews, October 2004, p. 729-759, Vol. 17, No. 4
0893-8512/04/$08.00+0     DOI: 10.1128/CMR.17.4.729-759.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Immunopathogenesis of Oropharyngeal Candidiasis in Human Immunodeficiency Virus Infection

Louis de Repentigny,1,2* Daniel Lewandowski,1 and Paul Jolicoeur3

Department of Microbiology and Immunology, Faculty of Medicine, University of Montreal,1 Sainte-Justine Hospital,2 Laboratory of Molecular Biology, Clinical Research Institute of Montreal Montreal, Quebec, Canada3

Oropharyngeal and esophageal candidiases remain significant causes of morbidity in human immunodeficiency virus (HIV)-infected patients, despite the dramatic ability of antiretroviral therapy to reconstitute immunity. Notable advances have been achieved in understanding, at the molecular level, the relationships between the progression of HIV infection, the acquisition, maintenance, and clonality of oral candidal populations, and the emergence of antifungal resistance. However, the critical immunological defects which are responsible for the onset and maintenance of mucosal candidiasis in patients with HIV infection have not been elucidated. The devastating impact of HIV infection on mucosal Langerhans' cell and CD4+ cell populations is most probably central to the pathogenesis of mucosal candidiasis in HIV-infected patients. However, these defects may be partly compensated by preserved host defense mechanisms (calprotectin, keratinocytes, CD8+ T cells, and phagocytes) which, individually or together, may limit Candida albicans proliferation to the superficial mucosa. The availability of CD4C/HIV transgenic mice expressing HIV-1 in immune cells has provided the opportunity to devise a novel model of mucosal candidiasis that closely mimics the clinical and pathological features of candidal infection in human HIV infection. These transgenic mice allow, for the first time, a precise cause-and-effect analysis of the immunopathogenesis of mucosal candidiasis in HIV infection under controlled conditions in a small laboratory animal.

* Corresponding author. Mailing address: Department of Microbiology and Immunology, Sainte-Justine Hospital and University of Montreal, 3175 Côte Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada. Phone: (514) 345-4643. Fax: (514) 345-4860. E-mail: louis.de.repentigny{at}umontreal.ca.

Clinical Microbiology Reviews, October 2004, p. 729-759, Vol. 17, No. 4
0893-8512/04/$08.00+0     DOI: 10.1128/CMR.17.4.729-759.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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