Skip to main content
Download PDF

Vitamin D deficiency and oral candidiasis in patients with HIV infection: A case‒control study

BMC Infectious Diseases volume 24, Article number: 217 (2024) Cite this article

Abstract

Background

Oral candidiasis is a common opportunistic infection in patients with human immunodeficiency virus (HIV). In addition, most of these patients suffer from vitamin D deficiency. This study aimed to investigate the association between vitamin D levels and oral candidiasis in patients with HIV infection.

Methods

This case‒control study was conducted on HIV-infected patients. Cases were patients with oral candidiasis diagnosed based on physical examinations. Controls were age- and sex-matched individuals without oral candidiasis. The levels of 25-OH vitamin D and other laboratory markers (CD4 count and viral load) were compared between the case and control groups.

Results

A total of 104 cases and 102 controls were included in the study. The cases had significantly lower 25-OH vitamin D3 levels (MD = 33.86 ng/mL, 95% CI= (31.85, 35.87), P < 0.001) and CD4 counts (MD = 267.48 cells/mm3, 95% CI= (189.55, 345.41), P < 0.001) than the controls. In addition, viral load was significantly higher in cases than in controls (MD = 7.03 × 105 copies/mL, 95% CI= (4.46 × 105, 9.61 × 105), P < 0.001). The multivariate logistic regression analysis revealed that educational status (OR = 0.032, 95% CI= (0.002, 0.100), P < 0.001), current HAART (OR = 0.005, 95% CI= (0.001, 0.014), P < 0.001), history of oral candidiasis (OR = 20.114, 95% CI= (18.135, 21.957), P < 0.001), CD4 count (OR = 0.004, 95% CI= (0.001, 0.006), P < 0.001), viral load (OR = 12.181, 95% CI= (1.108, 133.392), P < 0.001), and vitamin D level (OR = 0.011, 95% CI= (0.008, 0.015), P < 0.001) were significantly associated with the risk of developing oral candidiasis.

Conclusions

Based on the findings, most patients with HIV infection suffer from vitamin D deficiency, especially those with oral candidiasis. Hypovitaminosis D was significantly associated with an increased risk of oral candidiasis. Thus, vitamin D supplementation may assist HIV-positive patients in improving their oral health and preventing oral candidiasis.

Peer Review reports

Background

Oral candidiasis is a fungal infection of the tongue and oral cavity that is characterized by the invasion of Candida species into mucosal tissues. The majority of the general population carries Candida spp. as commensal organisms in the oral cavity. However, they may become pathogenic in immunocompromised hosts and cause opportunistic infections [1]. Predisposing factors for oral candidiasis can be divided into local (e.g., salivary dysfunction, smoking, and denture use) and systemic (e.g., age extremities, malignancies, endocrinopathies, malnutrition, certain medications, and immunocompetent conditions) subcategories [2]. In most cases, the disease manifests as pseudomembranous candidiasis, erythematous candidiasis, and angular cheilitis [3]. The treatment of oral candidiasis is achieved by administering prolonged antifungal medications and confronted with substantial challenges, including drug resistance, biofilm formation, and poor patient compliance [4].

Oral candidiasis is the most common opportunistic infection among patients with HIV infection. Approximately 95% of them experience at least one episode of oral candidiasis throughout their lifetime. It is estimated that over 9 million HIV-positive patients suffer from oral candidiasis worldwide [5]. It may be the initial manifestation of HIV infection or disease progression to acquired immunodeficiency syndrome (AIDS) [6]. Considering the high prevalence of oral candidiasis in HIV-positive patients, studies have focused on modifiable risk factors, such as malnutrition, to prevent it [7].

On the other hand, many individuals with HIV infection suffer from vitamin D deficiency. The prevalence of hypovitaminosis D in HIV-positive patients varies from 21.2% in New York, United States [8] to 92.6% in India [9]. Vitamin D plays a pivotal role in the oral health of patients with HIV by participating in innate and adaptive immune responses. Many immune cells, for instance, T lymphocytes, B lymphocytes, monocytes, and macrophages, express vitamin D receptor (VDR), which initiates intracellular pathways regulating the immune system [10]. HIV-positive patients with hypovitaminosis D are more likely to develop opportunistic infections such as tuberculosis and Cytomegalovirus infections [11]. Nevertheless, the available studies regarding the impact of vitamin D deficiency on oral candidiasis in HIV-infected individuals are limited [12]. Therefore, this study aimed to investigate the association between vitamin D levels and oral candidiasis in HIV-positive patients.

Methods

Study design and participants

The present case‒control study was retrospectively conducted at the Imam Khomeini Hospital Complex in Tehran, Iran, from July to October 2023. The study population included HIV-infected patients referred to the HIV clinic of Imam Khomeini Hospital. The inclusion criteria for the cases were as follows: a definitive diagnosis of HIV infection using repeated fourth-generation antigen/antibody combination immunoassay [13, 14], age above 18 years, willingness to participate in the study, and the diagnosis of oral candidiasis during the follow-up time. The control group met all of the above criteria, except for the diagnosis of oral candidiasis. Patients with the following features were excluded from the study: impaired salivary gland function; use of dentures; diabetes mellitus, Cushing’s syndrome, malignancy, and other immunocompetent conditions; and receiving vitamin D supplements, systemic/topical antifungal medications, oral mouthwashes, or corticosteroids in the preceding three months. In this study, samples from the case and control groups were matched by sex and age.

Sample size and sampling

Samples were recruited based on the consecutive sampling method. Initially, a pilot study was performed, which revealed the 25-OH Vitamin D levels in patients with oral candidiasis (n = 10, µ = 20.78, s = 28.45) and patients without oral candidiasis (n = 10, µ = 12.45, s = 10.20). Using the following formula, findings of the pilot study, r = 1, α = 5%, and power = 80%, the final sample size was estimated to be 206 (103 for each group).

$$ {\text{n}} = \frac{{r + 1}}{r} \times \frac{{\left( {s_1^2 \times s_2^2} \right) \times (A + B)}}{{{d^2}}}$$

Study procedure and data collection

Eligible samples were interviewed by a trained physician to record baseline characteristics, including age, sex, body mass index (BMI), educational status, and behavioral history. Medical records were reviewed to obtain the medical history and drug history of the patients. The above data were collected in a research-made checklist.

The diagnosis of oral candidiasis was established based on clinical manifestations on physical examinations [15]. Moreover, peripheral venous blood samples were taken from each patient by a trained nurse. They were transferred to the central laboratory of Imam Khomeini Hospital Complex at 20 °C to investigate the CD4 count (cells/mm3), viral load (copies/mL), and 25-OH vitamin D level (ng/mL). Vitamin D deficiency was considered as 25-OH vitamin D3 < 20 ng/mL [16]. Also, the AIDS was considered as CD4 count < 200 cells/mm3 [17].

Statistical analysis

The data were analyzed using SPSS software version 18.0 (SPSS Inc., Chicago, Illinois, USA). They were described as frequency (%), mean ± standard deviation (SD), mean difference (MD), and 95% confidence interval (CI). Categorical variables were compared between cases and controls using either the chi-square test or Fisher’s exact test, as indicated. Continuous variables were compared between cases and controls using independent-samples t-test. Box plots were designed on https://www.statisticskingdom.com. Furthermore, the association between the 25-OH vitamin D level and the risk of developing oral candidiasis was adjusted for confounding variables by applying multivariate logistic regression analysis. Variables with P < 0.10 in the univariate analysis were entered into a forward multivariate regression model (Wald method). Finally, findings were reported as odds ratios (ORs) and 95% CIs. In this study, a two-tailed P value below 0.05 was considered statistically significant.

Ethical considerations

The study was carried out in accordance with the Declaration of Helsinki 2000. The study protocol was approved by the Research Ethics Committees of Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, on June 28, 2023 (IR.TUMS.IKHC.REC.1402.129). Participants completed the written informed consent form.

Results

Baseline characteristics, medical history, and physical examinations

Table 1 presents the baseline characteristics and medical history of the patients. A total of 104 cases and 102 controls were included in the study. The baseline characteristics of the samples did not differ between groups, except for educational levels (P < 0.001) and drug abuse (P < 0.001).The majority of controls and some cases were receiving highly active antiretroviral therapy (HAART) (97.1% vs. 55.8%, P < 0.001). Furthermore, the prevalence of previous oral candidiasis was significantly higher in cases than in controls (17.3% vs. 0%, P < 0.001). Upon physical examination of patients diagnosed with oral candidiasis (Table 2), pseudomembranous candidiasis (96.2%) was the most common finding, followed by linear gingival erythema (4.8%), xerostomia (1.9%), and acute atrophic candidiasis (1.0%).

Table 1 Baseline characteristics and medical history of the patients
Full size table
Table 2 Clinical manifestations on physical examination of cases (n = 104)
Full size table

Laboratory findings of the patients

Figure 1 depicts laboratory results of the case and control groups. The cases had significantly lower CD4 counts (208.29 ± 161.16 vs. 475.78 ± 364.63, P < 0.001) and 25-OH vitamin D3 levels (13.84 ± 4.91 vs. 47.70 ± 9.05, P < 0.0001) than the controls. Most patients in the case group had vitamin D deficiency (89.4%). However, none of the patients in the control group had vitamin D deficiency (0%). Further analysis revealed that the prevalence of vitamin D deficiency between the mentioned groups differed significantly (P < 0.001). In addition, the viral load was significantly higher in cases than in controls (7.33 × 105±1.31 × 106 vs. 2.96 × 104±1.28 × 105, P < 0.001). Figure 2 illustrates 25-OH Vitamin D3 levels in the case and control groups by AIDS status. In the case group, patients with AIDS had significantly lower vitamin D3 levels than those without AIDS (12.58 ± 5.06 vs. 14.92 ± 4.54, P = 0.014). In control group, vitamin D3 levels did not differ between those with and without AIDS (48.10 ± 5.06 vs. 47.4 ± 10.41, P = 0.703).

Fig. 1
figure 1

Comparison of laboratory tests between the case and control groups A- The cases had significantly lower CD4 counts than the controls (MD = 267.48 cells/mm3, 95% CI= (189.55, 345.41), P < 0.001). B- The cases had significantly higher viral loads than the controls (MD = 7.03 × 105 copies/mL, 95% CI= (4.46 × 105, 9.61 × 105), P < 0.001). C- The cases had significantly lower 25-OH vitamin D3 levels than the controls (MD = 33.86 ng/mL, 95% CI= (31.85, 35.87), P < 0.001)

Full size image
Fig. 2
figure 2

25-OH Vitamin D3 levels in the case and control groups by AIDS status

Full size image

Multivariate logistic regression model

The multivariate analysis revealed that educational status (OR = 0.032, 95% CI= (0.002, 0.100), P < 0.001), current HAART (OR = 0.005, 95% CI= (0.001, 0.014), P < 0.001), history of oral candidiasis (OR = 20.114, 95% CI= (18.135, 21.957), P < 0.001), CD4 count (OR = 0.004, 95% CI= (0.001, 0.006), P < 0.001), viral load (OR = 12.181, 95% CI= (1.108, 133.392), P < 0.001), and vitamin D level (OR = 0.011, 95% CI= (0.008, 0.015), P < 0.001) were significantly associated with the risk of developing oral candidiasis. Table 3 shows findings of the multivariate logistic regression model regarding the effect of vitamin D level on oral candidiasis.

Table 3 Logistic regression analysis to adjust the effect of vitamin D level on oral candidiasis
Full size table

Discussion

Subsequent to the administration of HAART, the mortality rate of patients with HIV infection dropped dramatically. As the life expectancy of patients is prolonged, they face some chronic complications of HIV infection, such as opportunistic infections [18]. These infections can be prevented and treated by discovering risk factors. Thus, our study was conducted to investigate the effect of vitamin D on oral candidiasis among HIV-positive patients. Based on these findings, hypovitaminosis D was associated with an increased risk of developing oral candidiasis.

In agreement with our findings, Sroussi et al. reported that decreased vitamin D levels and CD4 counts augmented the risk of developing oral candidiasis in HIV-infected patients [12]. It was previously documented that CD4 count correlated with oral manifestations of AIDS [19]. CD4 count and viral load are the primary indicators of disease progression and response to treatment in patients with HIV infection. According to the literature, hypovitaminosis D is associated with decreased CD4 counts and increased viral loads. Vitamin D supplementation may be beneficial to the immune system by elevating CD4 count and diminishing viral load. In other words, vitamin D consumption, when combined with antiretroviral therapy, contributes to viral control [20]. In our study, some of the cases had vitamin D deficiency, even though their CD4 count was over 200 cells/mm3. Therefore, it is likely that oral candidiasis will develop in cases of vitamin D deficiency, even with CD4 > 200 cells/mm3.

Another study demonstrated that the following factors made HIV-infected individuals more susceptible to oral candidiasis: low CD4 count, high viral load, drug composition or nonuse of HAART, oral carriage of Candida spp., and a history of oral candidiasis [5], which is consistent with our findings. The controls in our study were more than the cases undergoing HAART. Antiretroviral therapy can reduce the risk of developing oral candidiasis through the enhancement of the immune system, secondary to the elevation of CD4 count [21]. A study by Gonçalves et al., in line with our findings, revealed that HIV-infected patients not receiving HAART mostly had oral candidiasis [21]. Interestingly, most patients with HIV infection who are on HAART suffer from hypovitaminosis D, which may be caused by certain antiretroviral drugs, especially Efavirenz. Thus, it is recommended that HIV-positive patients who are getting HAART receive vitamin D supplements [22].

Vitamin D is involved in the regulation of innate and adaptive immunity in combating HIV. The binding of vitamin D to VDR triggers pathways that overexpress anti-HIV molecules. Sufficient vitamin D can induce autophagy in components inhibiting HIV replication [23]. Furthermore, vitamin D plays a crucial role in the local immunity of the oral cavity. It contributes to the expression of antimicrobial peptides (e.g., cathelicidin and β-defensin 2). It participates in autophagy, phagosomal maturation, and antimicrobial activity of macrophages [24]. Hypovitaminosis D makes the oral cavity prone to opportunistic infections, such as oral candidiasis, by interfering with neutrophil recruitment and neutrophil oxidative functions [23]. Hypovitaminosis D can also lead to xerostomia, a condition in which the pathogenic Candida spp. (hyphae form) survive rather than the normal commensal flora (budding form). Fungal hyphae adhere to the oral epithelium and invade it by breaking down epithelial integrity. In a confrontation, vitamin D can trigger overexpression of RhoA and Ezrine proteins, which are involved in the enhancement of intercellular connections [25].

The multivariate analysis showed that lower educational status was associated with an increased risk of developing oral candidiasis. Patients with elementary education are less likely to know about health issues. They may have poor oral hygiene, which makes them more susceptible to oral infections. Additionally, a history of oral candidiasis was strongly associated with an increased risk of developing oral candidiasis. This may be due to the colonization of antibiotic-resistant Candida spp. in the oral cavity of these patients.

The current study had several limitations. We attempted to manage confounding variables by matching (e.g., age and gender) and restriction (e.g., endocrinopathy, some medications, and others that were excluded from the study). However, there may be some confounders that were not considered. For example, sufficient solar exposure as a natural source of vitamin D could have affected the results. We did not have any data regarding the previous levels of vitamin D over time. It is suggested to follow vitamin D fluctuation in HIV-positive patients over time in a prospective cohort study to discover whether it is associated with oral candidiasis.

Conclusions

Based on the findings, most patients with HIV infection suffer from vitamin D deficiency, especially those with oral candidiasis. Hypovitaminosis D was significantly associated with an increased risk of oral candidiasis. Thus, vitamin D supplementation may assist HIV-positive patients in improving their oral health and preventing oral candidiasis.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Hellstein JW, Marek CL. Candidiasis: Red and White manifestations in the oral cavity. Head Neck Pathol. 2019;13(1):25–32.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Vila T, Sultan AS, Montelongo-Jauregui D, Jabra-Rizk MA. Oral candidiasis: a Disease of Opportunity. J fungi (Basel Switzerland). 2020;6(1).

  3. Shekatkar M, Kheur S, Gupta AA, Arora A, Raj AT, Patil S, et al. Oral candidiasis in human immunodeficiency virus-infected patients under highly active antiretroviral therapy. Dis Mon. 2021;67(9):101169.

    Article  PubMed  Google Scholar 

  4. Nittayananta W. Oral fungi in HIV: challenges in antifungal therapies. Oral Dis. 2016;22(Suppl 1):107–13.

    Article  PubMed  Google Scholar 

  5. Ambe NF, Longdoh NA, Tebid P, Bobga TP, Nkfusai CN, Ngwa SB, et al. The prevalence, risk factors and antifungal sensitivity pattern of oral candidiasis in HIV/AIDS patients in Kumba District Hospital, South West Region, Cameroon. Pan Afr Med J. 2020;36:23.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Suryana K, Suharsono H, Antara I. Factors Associated with oral candidiasis in People Living with HIV/AIDS: a Case Control Study. HIV/AIDS (Auckland NZ). 2020;12:33–9.

    Google Scholar 

  7. Mehta S, Mugusi FM, Spiegelman D, Villamor E, Finkelstein JL, Hertzmark E, et al. Vitamin D status and its association with morbidity including wasting and opportunistic illnesses in HIV-infected women in Tanzania. AIDS Patient Care STDs. 2011;25(10):579–85.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kim JH, Gandhi V, Psevdos G Jr., Espinoza F, Park J, Sharp V. Evaluation of vitamin D levels among HIV-infected patients in New York City. AIDS Res Hum Retroviruses. 2012;28(3):235–41.

    Article  CAS  PubMed  Google Scholar 

  9. Deshwal R, Arora S. High prevalence of vitamin D Deficiency in HIV infected on antiretroviral therapy in a cohort of Indian patients. J Assoc Phys India. 2019;67(3):42–5.

    Google Scholar 

  10. Hsieh E, Yin MT. Continued interest and controversy: vitamin D in HIV. Curr HIV/AIDS Rep. 2018;15(3):199–211.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lee S, Lee JE, Lee SO, Sim YK, Lee SH. Influence of vitamin D Deficiency on the development of opportunistic infection in People Living with HIV/AIDS (PWHAs). J Am Coll Nutr. 2021;40(6):545–50.

    Article  CAS  PubMed  Google Scholar 

  12. Sroussi HY, Burke-Miller J, French AL, Adeyemi OM, Weber KM, Lu Y, et al. Association among vitamin D, oral candidiasis, and calprotectinemia in HIV. J Dent Res. 2012;91(7):666–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Branson BM, Owen SM, Wesolowski LG, Bennett B, Werner BG, Wroblewski KE et al. Laboratory testing for the diagnosis of HIV infection: updated recommendations. 2014.

  14. Nikolopoulos GK, Tsantes AG, Recent HIV, Infection. Diagnosis and Public Health Implications. Diagnostics (Basel Switzerland). 2022;12(11).

  15. Coronado-Castellote L, Jiménez-Soriano Y. Clinical and microbiological diagnosis of oral candidiasis. J Clin Experimental Dentistry. 2013;5(5):e279.

    Article  Google Scholar 

  16. Tabrizi R, Moosazadeh M, Akbari M, Dabbaghmanesh MH, Mohamadkhani M, Asemi Z, et al. High prevalence of vitamin D Deficiency among Iranian Population: a systematic review and Meta-analysis. Iran J Med Sci. 2018;43(2):125–39.

    PubMed  PubMed Central  Google Scholar 

  17. Lomelí-Martínez SM, González-Hernández LA, Ruiz-Anaya AJ, Lomelí-Martínez MA, Martínez-Salazar SY, Mercado González AE et al. Oral manifestations Associated with HIV/AIDS patients. Med (Kaunas Lithuania). 2022;58(9).

  18. Cao W, Hsieh E, Li T. Optimizing treatment for adults with HIV/AIDS in China: successes over two decades and remaining challenges. Curr HIV/AIDS Rep. 2020;17(1):26–34.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Vohra P, Jamatia K, Subhada B, Tiwari RVC, Althaf MN, Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim care. 2019;8(10):3247–52.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Alvarez N, Aguilar-Jimenez W, Rugeles MT. The potential protective role of vitamin D supplementation on HIV-1 infection. Front Immunol. 2019;10:2291.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Gonçalves LS, Júnior AS, Ferreira SM, Sousa CO, Fontes TV, Vettore MV, et al. Factors associated with specific clinical forms of oral candidiasis in HIV-infected Brazilian adults. Arch Oral Biol. 2013;58(6):657–63.

    Article  PubMed  Google Scholar 

  22. Steenhoff AP, Schall JI, Samuel J, Seme B, Marape M, Ratshaa B, et al. Vitamin D3supplementation in Batswana children and adults with HIV: a pilot double blind randomized controlled trial. PLoS ONE. 2015;10(2):e0117123.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Mumena CH, Mudhihiri MH, Sasi R, Mlawa M, Nyerembe S, Akimbekov NS, et al. The relevance of vitamin D in the oral health of HIV infected patients. J Steroid Biochem Mol Biol. 2021;211:105905.

    Article  CAS  PubMed  Google Scholar 

  24. Sudfeld CR, Duggan C, Aboud S, Kupka R, Manji KP, Kisenge R, et al. Vitamin D status is associated with mortality, morbidity, and growth failure among a prospective cohort of HIV-infected and HIV-exposed Tanzanian infants. J Nutr. 2015;145(1):121–7.

    Article  CAS  PubMed  Google Scholar 

  25. Gu Y, Baldwin S, Canning C, Hypovitaminosis D. Objective oral dryness, and fungal hyphae as three precipitating factors for a subset of secondary burning mouth syndrome. Heliyon. 2023;9(9):e19954.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors appreciate patients for their participation in the study.

Funding

The authors received no funding for this research project.

Author information

Authors and Affiliations

  1. Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran

    Shabnam Tehrani

  2. Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Shabnam Tehrani, Amirreza Keyvanfar, Azar Darvishi & AmirHossein Aghdaee

  3. Iranian Research Center for HIV/AIDS (IRCHA), Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Ladan Abbasian

  4. Department of Infectious Disease and Tropical Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Seyed Ali Dehghan Manshadi, Malihe Hasannezhad & Sara Ghaderkhani

Authors
  1. Shabnam Tehrani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ladan Abbasian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seyed Ali Dehghan Manshadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Malihe Hasannezhad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sara Ghaderkhani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amirreza Keyvanfar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Azar Darvishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. AmirHossein Aghdaee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ST conceptualized the study, collected the data and wrote primary draft of the manuscript. LA conceptualized the study and edited critically the manuscript. SADM interpreted the data and wrote primary draft of the manuscript. MH interpreted the data and wrote primary draft of the manuscript. SGh collected the data and wrote primary draft of the manuscript. AK designed the study, analyzed the data, and edited critically the manuscript. AD collected the data. AA collected the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Amirreza Keyvanfar.

Ethics declarations

Ethical approval and consent to participate

The study protocol was approved by the Research Ethics Committees of Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, on June 28, 2023 (IR.TUMS.IKHC.REC.1402.129). Participants completed the written informed consent form to participate.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tehrani, S., Abbasian, L., Dehghan Manshadi, S.A. et al. Vitamin D deficiency and oral candidiasis in patients with HIV infection: A case‒control study. BMC Infect Dis 24, 217 (2024). https://doi.org/10.1186/s12879-024-09065-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12879-024-09065-x

Keywords

BMC Infectious Diseases

ISSN: 1471-2334

Contact us