title: Incident and persistent vulvovaginal candidiasis among human immunodeficiency virus-infected women: Risk factors and severity.
abstract: OBJECTIVE
  To examine risk factors for vulvovaginal candidiasis among women with or at risk for human immunodeficiency virus (HIV) infection.
  
  
  METHODS
  Data were from 856 HIV-infected women and 421 at-risk uninfected women observed semiannually at four study sites from April 1993 through February 1999. At enrollment women were 15-55 years old and had no acquired immunodeficiency syndrome-defining conditions. Three definitions for vulvovaginal candidiasis of differing severity were constructed using data from vaginal Candida culture and Gram stains scored for yeast and three signs on pelvic examination (vulvovaginal edema, erythema, or discharge): 1) culture or Gram stain positivity plus at least one clinical sign, 2) culture or Gram stain positivity plus at least two clinical signs, and 3) visible yeast on Gram stain plus at least one clinical sign.
  
  
  RESULTS
  The prevalence and cumulative incidence of each definition of vulvovaginal candidiasis were greater among HIV-infected women than among women not infected with HIV (P <.01 for all comparisons). Stratified by status at the preceding visit, vulvovaginal candidiasis was most likely among women with prior vulvovaginal candidiasis, least likely among women without earlier Candida colonization, and intermediately likely among women with preceding subclinical Candida colonization. Among HIV-infected women, lower CD4 count and higher HIV viral load were associated with vulvovaginal candidiasis. Several other factors were independently associated with vulvovaginal candidiasis, with strong associations for diabetes mellitus and pregnancy in particular. Vulvovaginal candidiasis was not more severe among HIV-infected women.
  
  
  CONCLUSIONS
  Vulvovaginal candidiasis occurred with higher incidence and greater persistence, but not greater severity, among HIV-infected women.
authors.affiliation: National Center for Chronic Disease Prevention & Health Promotion, Division of Reproductive Health-HIV Section, Centers for Disease Control and Prevention, Mailstop K-34, 4770 Buford Highway NE, Atlanta, GA 30341-3717, USA. aduerr@cdc.gov
authors.forename: Ann
authors.initials: A
authors.lastname: Duerr
authors.forename: Charles M
authors.initials: CM
authors.lastname: Heilig
authors.forename: Susan F
authors.initials: SF
authors.lastname: Meikle
authors.forename: Susan
authors.initials: S
authors.lastname: Cu-Uvin
authors.forename: Robert S
authors.initials: RS
authors.lastname: Klein
authors.forename: Anne
authors.initials: A
authors.lastname: Rompalo
authors.forename: Jack D
authors.initials: JD
authors.lastname: Sobel
mesh_terms: D000293:Adolescent; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D002181:Candidiasis, Vulvovaginal / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D005260:Female; D015658:HIV Infections; D006801:Humans; D015994:Incidence; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D012008:Recurrence; D012237:Rhode Island / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D019562:Viral Load