The Evolution of Candida Species and Fluconazole Susceptibility among Oral and Vaginal Isolates Recovered from Human Immunodeficiency Virus (HIV)—Seropositive and At-Risk HIV-Seronegative Women

• Published in: The Journal of infectious diseases 2001-01, Vol.183 (2), p.286-293
• Main Authors: Sobel, Jack D., Ohmit, Suzanne E., Schuman, Paula, Klein, Robert S., Mayer, Kenneth, Duerr, Ann, Vazquez, Jose A., Rompalo, Anne
• Format: Article
• Language: English
• Subjects: Adult; AIDS; AIDS-Related Opportunistic Infections - microbiology; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; Antifungals; Biological and medical sciences; Candida; Candida - classification; Candida - drug effects; Candida - genetics; Candida - isolation & purification; Candida albicans - drug effects; Candida albicans - isolation & purification; Candidiasis; Candidiasis, Oral - drug therapy; Candidiasis, Oral - epidemiology; Candidiasis, Oral - microbiology; Candidiasis, Vulvovaginal - drug therapy; Candidiasis, Vulvovaginal - epidemiology; Candidiasis, Vulvovaginal - microbiology; Drug Resistance, Microbial; Epidemiology; Evolution; Female; Fluconazole - pharmacology; Fluconazole - therapeutic use; HIV; HIV Seronegativity; Human immunodeficiency virus; Human viral diseases; Humans; Infections; Infectious diseases; Lymphocytes; Major Articles; Medical sciences; Microbial colonization; Microbial Sensitivity Tests; Oral candidiasis; Oropharynx - microbiology; Pharmacology. Drug treatments; Risk Factors; Vagina - microbiology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/317936

Antifungal agents can effectively treat mucosal candidiasis; however, their use can lead to colonization with less susceptible species and to resistance among normally susceptible strains. Oral and vaginal Candida isolates obtained at 3 points over 2 years from human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women were identified by species and were evaluated for in vitro fluconazole susceptibility. Prevalence of non-C. albicans strains increased over time, and these strains were more likely among women reporting current antifungal use. Among C. albicans isolates, resistance was rare, with no evidence for progressive reduction in susceptibility over time. Among non-C. albicans isolates, reduced susceptibility occurred frequently and increased with time. HIV-seropositive women were more likely to have non-C. albicans isolates with reduced susceptibility as were women reporting current antifungal use. This evolution and selection of mucosa-colonizing Candida species with reduced susceptibility could play a critical early role in the development of antifungal resistance among C. albicans isolates responsible for refractory candidiasis.