Immune compromise and prevalence of Candida vulvovaginitis in human immunodeficiency virus-infected women.
OBJECTIVE
To investigate the effect of human immunodeficiency virus (HIV) infection on vaginal yeast colonization and symptomatic vulvovaginitis and to explore the effects of immune compromise on these conditions in HIV-positive women.


METHODS
Between September 1991 and May 1993, 223 HIV-positive women without AIDS-defining conditions were enrolled for prospective follow-up and compared with 289 HIV-negative women enrolled in a concurrent study. Standardized gynecologic assessment was carried out.


RESULTS
Cultures from 81 of 223 (36%) HIV-positive women and 72 of 289 (25%) HIV-negative women were positive for any yeast. The most commonly isolated yeasts were Candida albicans and Torulopsis glabrata; the proportion of non-C albicans isolates (26%) did not differ by serostatus. The rates of C albicans colonization and vulvovaginitis among immunocompetent (CD4 count at least 500 cells/mm3) HIV-positive women did not differ from those among HIV-negative women. Among HIV-positive women, risks for colonization and for symptomatic vulvovaginitis were increased approximately threefold and fourfold respectively, in women with CD4 counts below 200 cells/mm3 compared with either immunocompetent HIV-positive women or HIV-negative women.


CONCLUSIONS
The yeast species isolated from HIV-positive and HIV-negative women were similar. Rates of vaginal colonization and vaginitis were similar among nonimmunocompromised HIV-positive women and HIV-negative women. Elevated rates of yeast colonization and vaginitis were not seen among this population of HIV-infected women before immune compromise. Both vaginal colonization and symptomatic vaginitis increased with immune compromise among HIV-positive women, especially at CD4 counts below 200 cells/mm3.
Duerr
A
A
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Sierra
M F
MF
Feldman
J
J
Clarke
L M
LM
Ehrlich
I
I
DeHovitz
J
J
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D000328:Adult; D018791:CD4 Lymphocyte Count; D002181:Candidiasis, Vulvovaginal / Q000453:epidemiology* / Q000276:immunology; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D015995:Prevalence; D011446:Prospective Studies