title: Evolution of vaginal Candida species recovered from human immunodeficiency virus-infected women receiving fluconazole prophylaxis: the emergence of Candida glabrata? Terry Beirn Community Programs for Clinical Research in AIDS (CPCRA).
abstract: The effect of fluconazole prophylaxis on the vaginal flora of 323 human immunodeficiency virus-infected women was evaluated in a multicenter, randomized, double-blind, placebo-controlled trial. Women with CD4 cell counts of < or = 300/mm3 received either 200 mg of fluconazole per week or placebo. Vaginal surveillance cultures were performed every 3 months. After a follow-up of 29 months, Candida albicans was recovered from 53% of patients receiving fluconazole and 68% of patients assigned placebo. Fluconazole was associated with a 50% reduction in the odds of being colonized with C. albicans but with higher rates for non-albicans Candida species. Candida glabrata was recovered from 40 women assigned fluconazole and 29 assigned placebo (relative odds, 1.96; 95% confidence interval, 0.98-3.94). Fluconazole had an early and persistent effect on the vaginal mycoflora, with the emergence of C. glabrata vaginal colonization within the first 6 months. The effect of fluconazole prophylaxis can be attributed to the reduction in vaginal C. albicans colonization; however, C. glabrata colonization rapidly supervened.
authors.affiliation: Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan, USA. jvazquez@oncgate.roc.wayne.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Vazquez
authors.forename: J D
authors.initials: JD
authors.lastname: Sobel
authors.forename: G
authors.initials: G
authors.lastname: Peng
authors.forename: L
authors.initials: L
authors.lastname: Steele-Moore
authors.forename: P
authors.initials: P
authors.lastname: Schuman
authors.forename: W
authors.initials: W
authors.lastname: Holloway
authors.forename: J D
authors.initials: JD
authors.lastname: Neaton
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology* / Q000517:prevention & control; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D002176:Candida albicans / Q000187:drug effects / Q000302:isolation & purification; D002181:Candidiasis, Vulvovaginal / Q000382:microbiology* / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole