Risk Factors for Esophageal Candidiasis in Non-HIV Patients: A Systematic Review
Abstract
Esophageal candidiasis is commonly associated with HIV infection but also occurs in patients without HIV. This systematic review aimed to summarize risk factors for esophageal candidiasis in non-HIV patients. PubMed, the Cochrane Library, and ScienceDirect were searched for studies evaluating risk factors in non-HIV populations or reporting non-HIV subgroups separately, and the findings were synthesized qualitatively. Four studies met the inclusion criteria, comprising retrospective case–control and prospective observational studies in endoscopy-based settings. Reported prevalence among non-HIV patients ranged from 0.34% to 8.99%, depending on the population and case ascertainment. Corticosteroid use was the most consistently reported risk factor (odds ratios 2.05 to 6.67), and one study found a higher risk with higher doses. Proton pump inhibitor use (odds ratio 1.66), broad-spectrum antibiotic exposure (4.55), diabetes mellitus (7.34), malignancy (8.05), and increasing age (1.02 per year) were also reported, but proton pump inhibitor use and diabetes mellitus were significant in one study and not in another. Dysphagia and odynophagia predicted esophageal candidiasis in one prospective study, whereas a retrospective study found no correlation between symptoms and endoscopic severity. Corticosteroid exposure is the most consistent risk factor for esophageal candidiasis in non-HIV patients. Prospective multicenter studies with standardized definitions are needed to clarify the other associations.
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References
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