RISK-FACTORS FOR FLUCONAZOLE-RESISTANT CANDIDIASIS IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS

In a case-control study to identify risk factors for fluconazole-resis tant oroesophageal candidiasis in human immunodeficiency virus-infecte d patients, 25 patients with clinical and in vitro fluconazole-resista nt candidiasis were paired with controls who had treatment-responsive candidiasis and who had been observed for similar time periods. After their first episode of candidiasis, patients who later developed fluco nazole resistance had more treated episodes than did matched controls (cases, 3.1; controls, 1.8; P = .004), lower median CD4 cell counts (1 1/mm(3) vs. 71/mm(3); P = .004), and greater median durations of all a ntifungal therapy (419 vs. 118 days; P < .001) and of systemic azole t herapy (272 vs. 14 days; P < .001). When paired with a second set of c ontrols matched by CD4 cell count as well as first diagnosis of candid iasis, cases continued to show greater median exposure to azoles (272 vs. 88 days; P = .005). These data indicate that advanced immunosuppre ssion and exposure to oral azoles are risk factors for the development of fluconazole resistance.