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Updated: Jan 14, 2026
Whole Genome Sequencing of Candida glabrata for Detection of Markers of Antifungal Drug Resistance
Published on: December 28, 2017
Antifungal Resistance of Candida spp. Isolates From HIV/AIDS Patients in Iran 1999-2024: A Systematic Review and
Aliasghar Fakhri-Demeshghieh1, Ali Yousefipour2, Yousef Bolouki2
1DVM, Specialty Board-Certified in Epidemiology, Department of Food Hygiene and Quality Control, Epidemiology & Zoonoses Division of Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.
Background:
Antifungal resistance in Candida species in HIV/AIDS patients due to the scarcity of antifungal agents is important particularly in Iran with an estimate of 46,000 individuals living with HIV. This systematic review and meta-analysis aimed to determine the resistance rate of Candida spp. isolates from HIV/AIDS positive individuals in Iran from 1999 to 2024.
Methods:
PubMed, Scopus, Web of Science, MagIran, Scientific Information Database, and Google Scholar were searched and the title-and-abstract screening was performed independently by two review authors. The risk of bias assessment and the data extraction were performed independently by two review authors. Meta-analysis was performed using a random-effects model with Freeman-Tukey double arcsine transformation. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020.
Results:
From the retrieved 4925 references, 18 references belonging to 15 studies with 1318 Candida spp. isolates were included. The highest pooled resistance rate of Candida spp. was observed against clotrimazole (21%, 95% CI: 14-30, I2 = 67.29%) while the lowest pooled resistance rates of Candida spp. were observed against voriconazole, caspofungin, amphotericin B, and nystatin with the pooled estimates of 0%. At the species level, the highest pooled resistance rates were observed for Candida krusei against fluconazole (72%, 95% CI: 0%-100%) and itraconazole (38%, 95% CI: 17%-62%), and for Candida glabrata against clotrimazole (38%, 95% CI: 27%-50%).
Conclusions:
The use of amphotericin B, caspofungin, and nystatin for the treatment of Candida spp. in HIV-AIDS patients in Iran is recommended based on clinical indication.
Trial Registration:
PROSPERO ID: CRD42024540580.
Insights
Antifungal resistance in HIV/AIDS patients in Iran is a growing concern. This review recommends amphotericin B, caspofungin, and nystatin for Candida treatment due to low resistance rates.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Public Health
Background:
- Antifungal resistance in Candida species poses a significant challenge for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) patients.
- Iran has a substantial population of individuals living with HIV, highlighting the need for effective antifungal strategies.
- Limited availability of antifungal agents exacerbates the problem of drug resistance in this vulnerable population.
Purpose of the Study:
- To systematically review and meta-analyze the antifungal resistance rates of Candida species in HIV/AIDS patients in Iran.
- To identify specific Candida species and their resistance patterns to various antifungal agents.
- To provide evidence-based recommendations for antifungal therapy in HIV/AIDS patients in Iran.
Main Methods:
- A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, Web of Science, MagIran, Scientific Information Database, and Google Scholar.
- Systematic review and meta-analysis were performed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.
- Data extraction and risk of bias assessment were conducted independently by two reviewers, with meta-analysis utilizing a random-effects model.
Main Results:
- Fifteen studies comprising 1318 Candida spp. isolates were included in the analysis.
- The highest pooled resistance rate was observed against clotrimazole (21%).
- Notably, voriconazole, caspofungin, amphotericin B, and nystatin showed pooled resistance rates of 0%. Candida krusei and Candida glabrata exhibited higher resistance to specific agents like fluconazole, itraconazole, and clotrimazole.
Conclusions:
- Amphotericin B, caspofungin, and nystatin are recommended for treating Candida infections in HIV-AIDS patients in Iran due to their low resistance rates.
- These agents should be considered based on clinical indications for effective management of candidiasis in this population.
- Further research may be needed to monitor emerging resistance patterns and optimize treatment strategies.
