Clinical parameters associated with recalcitrant oral candidosis in HIV infection: a preliminary study

Clinical resistance in oropharyngeal candidosis is an increasingly significant management problem in HIV-seropositive patients. This study was undertaken to identify predisposing risk factors including the isolation of particular species of Candida which may be associated with the development of clinical resistance. The effect of particular antifungal prescribing regimens was also assessed. Data were compiled by chart review of 2 groups, each of 10 HIV-seropositive CDC stage IV patients with recurrent oropharyngeal candidosis. All patients had swabs taken at intervals during treatment and all candida isolates were species typed. The patients in group 1 exhibited candida infections which did not respond clinically to standard therapeutic regimens. The second patient group did respond to standard oral antifungal therapies. An association was found between the frequent utilization of azoles, particularly fluconazole and the development of clinically resistant oral candidosis. The number of candida isolates grown from the initial swab was also significantly related to the development of resistance.