Candidemia in HIV-infected subjects

The epidemiological features of 37 episodes of candidemia in HIV-infected s ubjects were analysed in a retrospective matched case-control study conduct ed over an 8-year period (1990-1997). Univariate analysis identified eight risk factors that were significantly associated with candidemia (P<0.05): i ) use of central venous catheters; ii) administration of total parenteral n utrition; iii) previous antifungal therapy; iv) previous therapy with glyco peptides; v) presence of oral/ esophageal candidiasis; vi) concomitant bact erial infections; vii) neutropenia; and viii) concomitant AIDS dementia com plex. Stepwise logistic regression analysis revealed that the only independ ent risk factor for developing candidemia was the use of central venous cat heters (P=0.0001). Candida albicans was the most frequently isolated pathog en, accounting for 18 (48%) episodes of candidemia, followed by Candida tro picalis (19%) and Candida glabrata (11%). The crude mortality rate was 62%. On univariate analysis concomitant opportunistic infections, presence of n on-Candida albicans species of Candida and neutropenia were shown to be pre dictive of death. Multivariate analysis revealed that the presence of non-C andida albicans strains of Candida was the only significant factor associat ed with a worse prognosis (P=0.001). In conclusion, candidemia appears to b e more common in patients with advanced HIV disease. Of the factors which i nfluenced the onset of candidemia, use of central venous catheters seemed t o be the most important one.