MOLECULAR EPIDEMIOLOGY OF MUCOSAL CANDIDIASIS IN HIV-POSITIVE WOMEN

Mucosal candidiasis is a common complication of HIV infection and HIV- positive women may develop both oropharyngeal and vaginal disease, Col onization with Candida albicans and related species at either site is a common preceding event in asymptomatic women, To examine the molecul ar epidemiology of colonizing yeast strains in HIV-positive women, con current oropharyngeal and vaginal cultures were obtained from 32 women (mean CD4 count 392 cells/mm(3), range 0-1319). Positive oropharyngea l cultures were obtained in 18 (56%) and positive vaginal cultures in 10 (31%), Candida species were isolated from both sites simultaneously in nine (28%) women, All strains were evaluated for restriction fragm ent length polymorphisms (RFLPs) at the ribosomal DNA locus (using a h eterologous 8.4-kb NotI probe from H. capsulatum) and with a C. albica ns-specific repetitive DNA probe, Isolates were grouped into three cla sses by the NotI probe and then members of each class were evaluated w ith the C. albicans-specific probe, Isolates were subsequently evaluat ed by random amplified polymorphic DNA (RAPD) PCR with four arbitrary primers to detect strain-specific differences, All isolates tested wer e unique and could be discriminated by RFLP or RAPD PCR, Vaginal and o ropharyngeal isolates from the same individual in all nine cases were dissimilar, suggesting that the dominant strain of Candida colonizing different body sites is different, These findings suggest that the epi demiology of Candida infection in HIV disease is complex, that the dev elopment of oropharyngeal and vaginal disease may be disassociated, an d that HIV-positive patients are each infected by their own unique str ains of Candida.