Vulvovaginal candidiasis: a comparison of HIV-positive and -negative women

Although considerable information has accumulated in the last decade regarding rates of both vaginal colonization and vulvovaginal candidiasis (VVC) in HIV-positive women, gaps in our knowledge remain, particularly with regard to pathophysiology of clinical disease. Unfortunately, early and possibly premature conclusions were reached in the late 1980s which resulted in the widespread dissemination of information indicating that recurrent VVC (RVVC) was a manifestation of HIV infection and that women with RVVC should be tested for HIV. Unfortunately, subsequent data from cohort studies involving HIV-positive women failed to determine attack rates of symptomatic Candida vaginitis requiring therapy. Recent studies indicate that Candida vaginitis, even if more frequent in HIV infected women, is clinically similar to that experienced in HIV-negative women and does not appear to be of increased clinical severity. VVC in HIV-positive women can be treated by conventional methods including the use of maintenance suppressive antifungal therapy and most importantly RVVC in women is not in itself a sentinel of HIV infection. Ongoing concerns include vaginal acquisition of non-albicans Candida species and the development of antimycotic drug resistance in C. albicans vaginal isolates.