IMMUNE COMPROMISE AND PREVALENCE OF CANDIDA VULVO-VAGINITIS IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED WOMEN

Objective: To investigate the effect of human immunodeficiency virus ( HIV) infection on vaginal yeast colonization and symptomatic vulvovagi nitis and to explore the effects of immune compromise on these conditi ons in HIV-positive women. Methods: Between September 1991 and May 199 3, 223 HIV-positive women without AIDS-defining conditions were enroll ed for prospective follow-up and compared with 289 HIV-negative women enrolled in a concurrent study. Standardized gynecologic assessment wa s carried out. Results: Cultures from 81 of 223 (36%) HIV-positive wom en and 72 of 289 (25%) HIV-negative women were positive for any yeast. The most commonly isolated yeasts were Candida albicans and Torulopsi s glabrata; the proportion of non-C albicans isolates (26%) did not di ffer by serostatus. The rates of C albicans colonization and vulvovagi nitis among immunocompetent (CD4 count at least 500 cells/mm(3)) HIV-p ositive women did not differ from those among HIV-negative women. Amon g HIV-positive women, risks for colonization and for symptomatic vulvo vaginitis were increased approximately threefold and fourfold, respect ively, in women with CD4 counts below 200 cells/mm(3) compared with ei ther immunocompetent HIV-positive women or HIV-negative women. Conclus ion: The yeast species isolated from HIV-positive and HIV-negative wom en were similar. Rates of vaginal colonization and vaginitis were simi lar among nonimmunocompromised HIV-positive women and HIV-negative wom en. Elevated rates of yeast colonization and vaginitis were not seen a mong this population of HIV-infected women before immune compromise. B oth vaginal colonization and symptomatic vaginitis increased with immu ne compromise among HIV-positive women, especially at CD4 counts below 200 cells/mm(3). (C) 1997 by The American College of Obstetricians an d Gynecologists.