The changing face of mycoses in patients with HIV/AIDS

The current era of effective antiretroviral therapy has led to a marked reduction in opportunistic infections (OIs) in those countries where such therapies are available. Opportunistic fungal infections are no exception, and the incidence of such infections is now 20% to 25% of that seen in the mid-1990s. Infections associated with very advanced HIV disease, such as azole-resistant candidiasis and aspergillosis, are also rarely seen, reflecting the improvement in immune function. Indeed, the most common issue now is whether patients who have had a systemic mycosis require life-long therapy as had been recommended. Preliminary data from small studies suggest that as with other OIs, it may be possible to stop suppressive therapy in patients with a history of mycosis whose CD4+ lymphocyte count rises with antiretroviral therapy. Thus, it appears that the future of HIV-associated mycoses is linked to the future of effective treatment for HIV itself.