Declining Rates of Oropharyngeal Candidiasis and Carriage ofCandida albicansAssociated with Trends Toward Reduced Rates of Carriage of Fluconazole‐ResistantC. albicansin Human Immunodeficiency Virus –Infected Patients

Abstract

In order to determine the current prevalence and incidence of fluconazole-resistant oropharyngeal candidiasis among human immunodeficiency virus (HIV)-infected patients, we conducted a prospective observational study of a consecutive series of HIV-infected patients. Of 128 enrolled patients, 70 patients completed four quarterly follow-up visits over a period of 1 year. Over this period, declining rates of carriage of Candida albicans (from 61% to 39%; P = .008) and of oropharyngeal candidiasis (from 30% to 4%; P < .001) were documented. Trends toward reduction in the frequency of fluconazole-resistant isolates (MIC, > or = 64 micrograms/mL) were also seen. During the survey period, the mean (median) number of antiretroviral agents used per patient rose from 0.5 (0) to 1.8 (2) (P < .001). Thus, rather than progression, we observed declining rates of oropharyngeal candidiasis, C. albicans carriage, and fluconazole-resistant C. albicans in a cohort of HIV-infected patients treated with increasingly effective antiretroviral therapy.

Global Trends in the Antifungal Susceptibility of Cryptococcus neoformans (1990 to 2004)

“…A similar improvement in fluconazole susceptibility among Candida albicans isolates from AIDS patients has been noted following the introduction of HAART (27). It was suggested that decreased use of antifungal agents in patients treated with effective antiretroviral therapy may have contributed to the decrease in fluconazole-resistant strains colonizing and infecting these individuals (27).…”

Altered CD4+ T Cell Phenotype and Function Determine the Susceptibility to Mucosal Candidiasis in Transgenic Mice Expressing HIV-1

“…Although the incidence of OPC in HIV infection has been significantly reduced since the introduction of highly active antiretroviral therapy (HAART) (2), it remains a common opportunistic infection in HIV-infected patients worldwide.…”

OralCandidaIsolates Colonizing or Infecting Human Immunodeficiency Virus-Infected and Healthy Persons in Mexico

“…Antifungal resistance to fluconazole (FCZ), itraconazole (ITZ), and ketoconazole (KTZ) has been described and particularly in the setting of oral candidiasis in HIV/AIDS patients (6,14,15,25,26). Cross-sectional surveys have indicated a prevalence of FCZ-resistant oral C. albicans isolates of 12 to 19% (20).…”

“…Cross-sectional surveys have indicated a prevalence of FCZ-resistant oral C. albicans isolates of 12 to 19% (20). Before the use of HAART, Martins et al (14,15) found a prevalence of Candida spp. resistant to FCZ of 22% in North Americans with oral candidiasis and of 14% in asymptomatically colonized patients.…”