Evolution of vaginal Candida species recovered from human immunodeficiencyvirus-infected women receiving fluconazole prophylaxis: The emergence of Candida glabrata?

The effect of fluconazole prophylaxis on the vaginal flora of 323 human imm unodeficiency virus-infected women was evaluated in a multicenter, randomiz ed, double-blind, placebo-controlled trial. Women with CD4 cell counts of l ess than or equal to 300/mm(3) received either 200 mg of fluconazole per we ek or placebo. Vaginal surveillance cultures were performed every 3 months. After a follow-up of 29 months, Candida albicans was recovered from 53% of patients receiving fluconazole and 68% of patients assigned placebo. Fluco nazole was associated with a 50% reduction in the odds of being colonized w ith C. albicans but with higher rates for non-albicans Candida species. Can dida glabrata was recovered from 40 women assigned fluconazole and 29 assig ned placebo (relative odds, 1.96; 95% confidence interval, 0.98-3.94). Fluc onazole had an early and persistent effect on the vaginal mycoflora, with t he emergence of C. glabrata vaginal colonization within the first 6 months. The effect of fluconazole prophylaxis can be attributed to the reduction i n vaginal C. albicans colonization; however, C. glabrata colonization rapid ly supervened.