Low level of antifungal resistance in Candida species recovered from Iranian HIV-associated oral infection

Oral candidiasis (OC) is the most frequent opportunistic fungal infection, which is a predictive indicator of immunosuppression and disease progression among people living with HIV/AIDS (PLWHA). In the present study, 109 Candida isolates were collected from 94 PLWHA afflicted with oral Candida infection (OCI) following highly active antiretroviral therapy (HAART). The susceptibility profiles of Candidaspp. to six antifungal agents were evaluated using CLSI broth microdilution. The prevalence of OCI was 34.06%. The susceptibility profile of Candidaspp. revealed 100% sensitivity to caspofungin, while 6.4%, 5.4%, 24.5%, and 2.8% of Candida isolates showed resistance or nonwild-type MICs to fluconazole, itraconazole, posaconazole, and amphotericin B, respectively. Notably, 15.9% of patients and 3.7% of isolates showed mixed Candida infections and multidrug resistance, respectively. The low-level resistance to antifungal agents observed in the present study may be explained by the fact that none of the participants had prior and prolonged exposure to these antifungals. However, more focus should be placed on the mechanisms of reduced susceptibility and low-level resistance in Candida species since they can serve as stepping stones to developing clinical resistance. Alongside this, it seems a must to understand the local epidemiology of Candida spp. and their susceptibility pattern.

 

Comments：

The present study investigated oral candidiasis (OC) among people living with HIV/AIDS (PLWHA) who had received highly active antiretroviral therapy (HAART). The study found a high prevalence of OCI (34.06%) among the participants. Candida isolates collected from these patients were evaluated for their susceptibility to six antifungal agents using CLSI broth microdilution. The study found that caspofungin had 100% sensitivity, while fluconazole, itraconazole, posaconazole, and amphotericin B showed varying degrees of resistance or non-wild-type MICs among Candida isolates. The low-level resistance to antifungal agents observed in the study may be due to the absence of prior and prolonged exposure to these antifungals. However, the study highlights the need to understand the mechanisms of reduced susceptibility and low-level resistance in Candida species since they may lead to the development of clinical resistance. Additionally, the local epidemiology of Candida spp. and their susceptibility patterns should be considered in the management of OCI among PLWHA.

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Fungal