MIXED OROPHARYNGEAL CANDIDIASIS DUE TO CANDIDA-ALBICANS AND NON-ALBICANS CANDIDA STRAINS IN HIV-INFECTED PATIENTS

In order to determine the clinical significance of mixed oropharyngeal candidiasis (Candida albicans plus a non-albicans strain of Candida) in patients infected with HIV-1, a retrospective chart review was done in 12 HIV-1-infected patients with a clinical episode of oropharyngea l candidiasis, in whom a mixed culture of Candida albicans (found to b e fluconazole-sensitive) plus a non-albicans species of Candida was ob tained from their oral cavities. This group was compared with 26 HIV-p ositive patients (control group) with oropharyngeal candidiasis due to Candida albicans (found to be fluconazole-sensitive). Antifungal susc eptibility testing was performed by a broth microdilution test with RP MI-2% glucose. A fungal strain was considered fluconazole-sensitive if its MIC was < 0.5 mu g/ml. Both the study and control groups had simi lar clinical and demographic characteristics. All the patients were se verely immunocompromised, with a mean CD4+ lymphocyte count of 63/mm(3 ) (95% CI 41-84) and 80/mm(3) (95% CI 25-135) in the study and control groups, respectively. in the study group, seven patients had Candida albicans and Candida krusei in their oral cavity, four had Candida alb icans and Candida glabrata, and one had Candida albicans and Candida t ropicalis. Antifungal therapy consisted of ketoconazole (5 patients in the study group, 14 in the control group) or fluconazole (7 patients in the study group, 12 in the control group); no statistically signifi cant difference in clinical outcome was observed. Fungal strain persis tence after therapy was frequently observed in both groups. It is conc luded that non-albicans strains of Candida, less sensitive to azole dr ugs than their Candida albicans counterparts, are not clinically relev ant in episodes of mixed oropharyngeal candidiasis in HIV-1-infected p atients.