Evolution of antifungal susceptibility among Candida species isolates recovered from human immunodeficiency virus-infected women receiving fluconazole prophylaxis

The effect of fluconazole on the susceptibility of Candida isolates recover ed from women infected with human immunodeficiency virus (HIV) was evaluate d in a randomized, double-blind, placebo-controlled trial. Women with CD4() cell counts of less than or equal to 300 cells/mm(3) received either fluc onazole (200 mg/week) or placebo as prophylaxis. The antifungal susceptibil ity of specimens was evaluated. One patient who received fluconazole and 2 patients assigned to placebo had Candida albicans isolates recovered that w ere resistant to fluconazole (MIC, greater than or equal to 64 mug/mL). Ele ven patients assigned fluconazole and 4 patients assigned placebo had non-a lbicans Candida strains (all Candida glabrata) recovered that were resistan t to fluconazole. There was significant azole cross-resistance among the no n-albicans Candida species isolates. Although the rate of azole resistance did not significantly increase after fluconazole prophylaxis, there was a t rend toward more in vitro azole resistance in C. glabrata isolates from pat ients assigned fluconazole. Moreover, the majority of resistant vaginal iso lates of Candida species were recovered after initiation of open-label fluc onazole use.