Malassezia yeast population dynamics on the skin of patients living with HIV

Malassezia species are lipid-dependent yeasts of the normal skin mycobiota in humans and some animals. Yet, both the dynamic of Malassezia skin colonization and the associated fungal and bacterial skin microbiome remain unknown in HIV+ patients. This study aimed to compare Malassezia yeast community structure and associated microbiome on the healthy skin of HIV+ patients and healthy controls. A total of 23 HIV+ patients and 10 healthy controls were included and followed-up for a maximum of 5 visits over 10-17 months. At each visit, chest, face, nasolabial fold, and scalp skin samples were subjected to both culture and MALDI-TOF MS identification, and ITS/16S metabarcoding. The participants were categorized according to their Malassezia colony forming unit (CFU) abundance. Malassezia were cultured from each participant at each visit. HIV+ patients were highly colonized on all visits with CFU > 100. Malassezia sympodialis and M. globosa were the most dominant species. Malassezia furfur and M. dermatis were more prevalent in HIV+ than in healthy participants. Malassezia sympodialis prevalence was stable at each sampling sites over time. Malassezia furfur prevalence was stable and more abundant over time on HIV+ patients' chest. The metabarcoding analysis suggested a higher fungal and bacterial diversity and an increased abundance of Cladosporium halotolerans and Streptococcus in HIV+ patients than in controls. Overall, HIV+ patients display a high skin colonization by Malassezia yeasts and a dysbiosis of both fungal and bacterial communities.