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).
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.
Vazquez
J A
JA
Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan, USA. jvazquez@oncgate.roc.wayne.edu
Sobel
J D
JD
Peng
G
G
Steele-Moore
L
L
Schuman
P
P
Holloway
W
W
Neaton
J D
JD
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
D000935:Antifungal Agents; D015725:Fluconazole