• HIV;
  • oral candidiasis;
  • oral hygiene;
  • randomized controlled trials;
  • self-care

Abstract – Objectives: This single-blind randomized controlled pilot study evaluated the efficacy of a behavioral intervention program, PRO-SELF: Candidiasis, to reduce time to recurrence of oral candidiasis over 6 months in susceptible HIV-seropositive persons. The intervention involved instruction by dentists on improving oral hygiene, minimizing sugar intake, and self-diagnosing candidiasis. Methods: Participants were adults with oral candidiasis responsive to antifungals who presented to the UCSF Stomatology Clinic between 1997 and 2000. At 2–3 weeks of follow-up visits, a dentist ‘examiner’, masked to group assignment, quizzed participants as to the presence of candidiasis, and assessed candidiasis status. A second, unmasked dentist ‘instructor’ then delivered the program to intervention participants. Participants recorded dietary and oral hygiene practices in 24-h recall diaries: intervention participants at each visit and controls at initial and final visits. Results: At randomization, CD4+ cell counts (cells/mm3) were 298 ± 188 among 18 intervention participants and 396 ± 228 among 17 controls. The candidiasis recurrence rates at 6 months were 78% among intervention compared with 88% among control participants (hazard ratio 0.72; 95% CI 0.35–1.50). Performing oral hygiene after meals/snacks showed the largest relative improvement: intervention–control difference in proportion of meals/snacks affected was 24% (95% CI −1 to 48%). Self-diagnoses of candidiasis were inaccurate, possibly because of mild episodes. Conclusions: The results weakly indicate that regular instruction from healthcare professionals helps patients delay candidiasis recurrence by improving oral hygiene. Among HIV-seropositive persons, those with poor oral hygiene, and high-sugar diets are most likely to benefit.