[Oropharyngeal candidiasis resistant to fluconazole in patients infected by HIV].
OBJECTIVE
To study the susceptibility to fluconazole of Candida albicans strains in oral candidiasis of HIV positive patients.


METHODS
Eleven HIV positive patients with confirmed oral candidiasis were included in a 4 to 10 months prospective study. In addition, 23 HIV positive patients were evaluated in a restrospective study (14 with oral candidiasis and 9 control subjects). The MICs to fluconazole of C. albicans were characterized by genotyping (electrophoretic karyotype).


RESULTS
Thirty patients were evaluable. Oral candidiasis was found in 21 patients; 7/21 patients (33,3 p. 100) developed resistant C. albicans strain (MIC > 32 mg/ml) after a mean fluconazole cumulative dose of 18 g. In this study, the electrophoretic karyotype confirmed the persistence of the same C. albicans strain in each patient. In addition increased colonization by C. krusei or C. glabrata was found in 6/21 patients (28.5 p. 100).


CONCLUSIONS
Our data demonstrate that prolonged treatment with fluconazole dose higher than 13 g induces the emergence of resistant C. albicans with persistence of the same C. albicans strain. Fluconazole has to be reserved to oral candidiasis after failure of a local treatment or to severe cases.
Drobacheff
C
C
Service de Dermatologie II, CHRU, Besançot.
Manteaux
A
A
Millon
L
L
Reboux
G
G
Barale
T
T
Laurent
R
R
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000382:microbiology*; D000328:Adult; D000935:Antifungal Agents / Q000737:chemistry / Q000627:therapeutic use*; D002176:Candida albicans / Q000187:drug effects; D002180:Candidiasis, Oral / Q000188:drug therapy* / Q000209:etiology; D004351:Drug Resistance; D005260:Female; D015725:Fluconazole / Q000737:chemistry / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies
D000935:Antifungal Agents; D015725:Fluconazole
Candidoses oropharyngées résistantes au fluconazole chez des malades infectés par le VIH.