The evolution of Candida species and fluconazole susceptibility among oraland vaginal isolates recovered from human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women

Antifungal agents can effectively treat mucosal candidiasis; however, their use can lead to colonization with less susceptible species and to resistan ce among normally susceptible strains. Oral and vaginal Candida isolates ob tained at 3 points over 2 years from human immunodeficiency virus (HIV)- se ropositive and at- risk HIV- seronegative women were identified by species and were evaluated for in vitro fluconazole susceptibility. Prevalence of n on- C. albicans strains increased over time, and these strains were more li kely among women reporting current antifungal use. Among C. albicans isolat es, resistance was rare, with no evidence for progressive reduction in susc eptibility over time. Among non- C. albicans isolates, reduced susceptibili ty occurred frequently and increased with time. HIV- seropositive women wer e more likely to have non- C. albicans isolates with reduced susceptibility as were women reporting current antifungal use. This evolution and selecti on of mucosa- colonizing Candida species with reduced susceptibility could play a critical early role in the development of antifungal resistance amon g C. albicans isolates responsible for refractory candidiasis.