ORAL CANDIDA IN HIV-INFECTION AND AIDS - NEW PERSPECTIVES NEW APPROACHES

Oral candidosis has become an increasingly important problem in HIV-in fected individuals. At present, the small body of published literature on the characterization of the Candida strains and species found in H IV+ patients is full of confusion and contradictions. Some of these di fficultues are the result of the methodological shortcomings of a numb er of the techniques that have been used. Examples of the problems tha t may be encountered on primary isolation and subculture are described and the drawbacks associated with the systems used to date for phenot yping Candida are quoted. While molecular characterization techniques would appear to offer a reliable and objective alternative, they too h ave their strengths and weaknesses. An attempt is made to summarize th e progress that has been made recently in the detection and identifica tion of Candida albicans and also the non-albicans species from HIV-in fected individuals. What emerges is that the commensal Candida species that inhabit the oral cavities of HIV+ patients are subjected to a nu mber of significant pressures that probably promote the selection of o rganisms with unusual phenotypes and genotypes. These Candida are more difficult to characterize and behave differently compared to their co unterparts in HIV- individuls. It is clear that uncovering the factors that are important for the selection of treatment regimens and will b e predictive of outcome will not be easy. Candida organisms are neithe r as benign nor as simple as once thought.