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Infection and Immunity, April 2004, p. 1956-1963, Vol. 72, No. 4
0019-9567/04/$08.00+0     DOI: 10.1128/IAI.72.4.1956-1963.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Salivary Secretory Leukocyte Protease Inhibitor and Oral Candidiasis in Human Immunodeficiency Virus Type 1-Infected Persons

Amit Chattopadhyay,1 Laurie R. Gray,1 Lauren L. Patton,1 Daniel J. Caplan,1 Gary D. Slade,2 Hsaio-Chuan Tien,3 and Diane C. Shugars1,4*

Schools of Dentistry,1 Public Health,3 Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,4 School of Dentistry, University of Adelaide, Adelaide, Australia2

Received 5 September 2003/ Returned for modification 14 October 2003/ Accepted 5 January 2004

Oropharyngeal candidiasis, typically caused by Candida albicans, is the most common oral disease associated with human immunodeficiency virus type 1 (HIV-1) infection. Secretory leukocyte protease inhibitor (SLPI), a 12-kDa antiprotease, suppresses the growth of C. albicans in vitro. To determine whether the mucosal protein plays a role in protecting oral tissues against fungal infection, we conducted a cross-sectional study investigating the oral and systemic health and salivary SLPI levels in 91 dentate HIV-1-infected adults receiving medical care in the southeastern United States. Participants with a self-reported history of clinical oropharyngeal candidiasis during the previous 2 years constituted the test group (n = 52), while the comparison group (n = 39) had no oropharyngeal candidiasis during that period. Data collected from medical records, oral examination, and SLPI enzyme-linked immunosorbent assay quantitation of whole saliva were analyzed by t test, analysis of variance, linear regression, and unconditional logistic regression. The test group had a significantly higher mean salivary SLPI level than the comparison group (1.9 µg/ml versus 1.1 µg/ml, P < 0.05). Linear regression modeling identified CD4 cell count and history of oropharyngeal candidiasis as key predictors of salivary SLPI and revealed a significant interaction (P < 0.05) between immunosuppression (CD4 cell count below 200 cells/µl) and positive history of oropharyngeal candidiasis in predicting salivary SLPI level. By logistic regression modeling, a salivary SLPI level exceeding 2.1 µg/ml, low CD4 count, antiretroviral monotherapy, and smoking were key predictors of oropharyngeal candidiasis. These data support a key role for SLPI in the oral mucosal defense against C. albicans. The antimicrobial mucosal protein may serve as an indicator of previous oropharyngeal candidiasis infection among immunosuppressed persons.

* Corresponding author. Mailing address: Room 311, Dental Research Center, CB #455, Chapel Hill, NC 27599-7455. Phone: (919) 966-5310. Fax: (919) 966-6761. E-mail: diane_shugars{at}dentistry.unc.edu.

Editor: T. R. Kozel

Infection and Immunity, April 2004, p. 1956-1963, Vol. 72, No. 4
0019-9567/04/$08.00+0     DOI: 10.1128/IAI.72.4.1956-1963.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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