Vaginal colonization with Candida spp. in human immunodeficiency virus – infected women: a cohort study

Abstract

We have conducted a longitudinal study on factors associated with candidal vaginal colonization, a precursor of vaginitis, in a cohort of HIV-infected women in Italy. All consecutive women attending a single, tertiary care clinical site were offered free screening for sexually transmitted infections and genital disorders every 6-12 months. Candidal vaginal colonization was defined as a positive culture for Candida spp. in an asymptomatic woman. From January 1998 to July 2002 we analysed 214 women. The baseline prevalence of candidal vaginal colonization was 16.8%. In the logistic regression analysis, the time since HIV infection > or =36 months (odds ratio [OR] = 0.18, 95% confidence interval [CI] 0.016-0.53, P = 0.002) and a plasma viral load > or =10,000 copies/mL (OR = 3.9, 95% CI 1.03-14.9, P = 0.045) were independently associated with candidal colonization. Among 130 women who were followed for a mean period of 24 months, the incidence of vaginal colonization was 10.7/100 women-years. In the Cox regression analysis, a CD4(+) T-lymphocytes count <100 cells/microL during the follow-up was associated with an increased risk of candidal vaginal colonization (OR = 4.45, C.I. = 1.20-16.81, P = 0.03). Risk of candidal vaginal colonization episodes in HIV-infected women significantly increase when CD4(+) T-lymphocytes are less than 100.

Candida species isolated from the vaginal mucosa of HIV-infected women in Salvador, Bahia, Brazil

“…In other countries such as Italy and the United States, the frequency was higher ranging from 81% to 92%, compared to that found in our study (52.9%). 10,11,18 In HIV-uninfected patients, our data was similar to other studies performed in Brazil, which describe the prevalence of C. albicans isolated in vaginal samples ranging from 60% to 80% 19,20 and in other countries where the prevalence of C. albicans in vaginal samples ranges between 80% to 90%. 1,11,21,22 A higher diversity of non-albicans species was found in HIV-infected patients compared to uninfected controls.…”

“…7,8 Factors which predispose to VVC include: pregnancy, uncontrolled diabetes mellitus, corticosteroids or systemic/ vaginal antibiotic therapy, HIV infection, and Candida vaginal colonization (CVC). 9,10 The frequency of VVC caused by other Candida species, such as Candida tropicalis, Candida glabrata, and Candida krusei is increasing, especially in HIV-infected women. 5,8,11 C. albicans and C. glabrata are responsible for the majority of VVC cases in HIV-infected women.…”

“…5,8,11 C. albicans and C. glabrata are responsible for the majority of VVC cases in HIV-infected women. 10,12 Although resistance to azoles antifungal therapy is rare in C. albicans isolates (1%), it is becoming commonplace among C. glabrata isolates (up to 15%) as well as among other non-albicans species. 5,10,13,14 Few studies in Brazil have assessed the prevalence of VVC in HIV-infected women undergoing highly active antiretroviral therapy (HAART) treatment.…”

“…10,12 Although resistance to azoles antifungal therapy is rare in C. albicans isolates (1%), it is becoming commonplace among C. glabrata isolates (up to 15%) as well as among other non-albicans species. 5,10,13,14 Few studies in Brazil have assessed the prevalence of VVC in HIV-infected women undergoing highly active antiretroviral therapy (HAART) treatment. 15 The aim of this study was to determine the frequency of VVC and to describe the main Candida species isolated in HIV-infected patients, compared to HIV-uninfected women in Salvador, Brazil.…”

Molecular diagnosis of vaginal candidiasis by polymerase chain reaction (PCR) and random amplification polymorphism DNA (RAPD-PCR) in Babylon Province, Iraq

“…Ozcan et al (2006) reported that C. glabrata is responsible for 14% of infections in immune competent women. Candida is a member of normal flora in vagina and oral cavity; however, there are many predisposing factors that can lead to these infections such as pregnancy, long term use of antibiotics, diabetes mellitus, using of corticosteroids, HIV infection, and being immunocompromised (Fidel and Sobel, 1996;Duerr et al, 1997Duerr et al, , 2003Corsello et al, 2003;Beltramene et al, 2006). *Corresponding author.…”