Question

You answered a question December/12 saying that having thrush does not necessarily mean you have low cd4. I have 800 (tests just a week ago) and I have slight thrush on my tongue (never happened before), does not seem to progress any further but it has been diagnosed by test. Took Diflucan, Mycostatin and others and is not going away. I smoke a lot, could it be that?. My doctor has told me to stop all products and just use bicarbonate (sorry spelling mistakes-foreign). What can I do for it to go away, and do you not think is a sign that something is happening with my inmune system?. Also could it be due to taking Hydrea (hydroxurea), because it seems clear that Hydrea produces sores in mouth and slight white spots in nails. Thank you very much.

Answer

The organism that leads to thrush is most cases is Candida albicans, which happens to be a commensal organism. In other words, the fact that your primary care provider was able to culture out "yeast" or Candida is not unusual as the majority of people with or without HIV-infection will be culture positive. Another interesting point you mention is the spectrum of antifungals you have been on without success. Diflucan is a very effective systemic antifungal agent that should easily be able to overcome a minor bout of candidiasis. My conclusion: you probably do not have thrush.

What you have described sounds very much like coated tongue which is simply an overgrowth of the normal tongue papillae which then in turn serves as a trap for bacteria. Smoking is a definitive risk factor for the development of coated tongue. Treatment for this condition would be to gently brush your tongue every time you brush your teeth.

Hope this helps!

DR