An increased prevalence of candidal carriage and oral candidiasis is common in cases of human immunodeficiency virus (HIV) infection, and the reasons for this may include the enhanced ability of colonizing yeasts to produce biofilms on mucosal surfaces. The aim of the present study was therefore to examine the differences, if any, in the biofilm-forming abilities of 26 Candida albicans yeast isolates from HIV-infected individuals and 20 isolates from HIV-free individuals, as this attribute of yeast isolates from patients with HIV disease has not been examined before. Biofilm formation in microtiter plate wells was quantitatively determined by both the 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide (XTT) reduction method and the crystal violet method. Although candidal biofilm formation could be quantitatively evaluated by either technique, the better reproducibility (P < 0.05) of the XTT reduction assay compared with that of the crystal violet method led us to conclude that the former is more reliable. There were no significant quantitative differences in biofilm formation between C. albicans isolates from HIV-infected patients and isolates from HIV-free individuals during in vitro incubation in a multiwell culture system over a period of 66 h. Three of eight host factors in the HIV-infected group were found to be associated with candidal biofilm formation. Thus, yeasts isolated from older individuals and those with higher CD4-cell counts exhibited decreased biofilm formation, while the findings for yeasts from individuals receiving zidovudine showed the reverse (P < 0.05 for all comparison). Our data indicate that attributes other than biofilm formation may contribute to the increased oral yeast carriage rates in cases of HIV infection.Candida biofilms have recently received considerable attention due to their high prevalence on catheter surfaces (1) and their notorious resistance to antifungals (14, 29). These characteristics of Candida biofilms are likely to contribute to both superficial (26) and systematic candidiasis (21). As candidal infections are the most common fungal infections in individuals infected with the human immunodeficiency virus (HIV) (27), we hypothesized that isolates recovered from HIV-infected individuals may have better biofilm-forming abilities than those recovered from HIV-free individuals.A number of workers have compared the adherence of Candida albicans yeast isolates from HIV-infected patients and HIV-free subjects to mucosal surfaces, as adherence to host surfaces is a prerequisite for subsequent biofilm formation and colonization (12). However, those studies have yielded variable results showing enhanced adherence to buccal epithelial cells (BECs) by yeast isolates from HIV-positive individuals (32), a comparable degree of adhesion between test and control isolates (34), and an even higher degree of adhesion by control isolates (23). To our knowledge, no group has studied the biofilm-forming abilities of Candida isolates recovered fr...