Mixed oropharyngeal candidiasis due to Candida albicans and non-albicans Candida strains in HIV-infected patients

In order to determine the clinical significance of mixed oropharyngeal candidiasis (Candida albicans plus a non-albicans strain ofCandida) in patients infected with HIV-1, a retrospective chart review was done in 12 HIV-1-infected patients with a clinical episode of oropharyngeal candidiasis, in whom a mixed culture ofCandida albicans (found to be fluconazole-sensitive) plus a non-albicans species ofCandida was obtained from their oral cavities. This group was compared with 26 HIV-positive patients (control group) with oropharyngeal candidiasis due toCandida albicans (found to be fluconazole-sensitive). Antifungal susceptibility testing was performed by a broth microdilution test with RPMI-2% glucose. A fungal strain was considered fluconazole-sensitive if its MIC was < 0.5 μg/ml. Both the study and control groups had similar clinical and demographic characteristics. All the patients were severely immunocompromised, with a mean CD4+ lymphocyte count of 63/mm3 (95% Cl 41–84) and 80/mm3 (95% Cl 25–135) in the study and control groups, respectively. In the study group, seven patients hadCandida albicans andCandida krusei in their oral cavity, four hadCandida albicans andCandida glabrata, and one hadCandida albicans andCandida tropicalis. Antifungal therapy consisted of ketoconazole (5 patients in the study group, 14 in the control group) or fluconazole (7 patients in the study group, 12 in the control group); no statistically significant difference in clinical outcome was observed. Fungal strain persistence after therapy was frequently observed in both groups. It is concluded that non-albicans strains ofCandida, less sensitive to azole drugs than theirCandida albicans counterparts, are not clinically relevant in episodes of mixed oropharyngeal candidiasis in HIV-1-infected patients.