title: Mechanisms of resistance to fluconazole in Candida albicans clinical isolates from Iranian HIV-infected patients with oropharyngeal candidiasis.
abstract: OBJECTIVE
  The opportunistic pathogen Candida albicans is the major agent of oropharyngeal candidiasis (OPC) in HIV/AIDS patients. The increased use of fluconazole can lead to the emergence of azole-resistant strains and treatment failures in PLWH (people living with HIV) receiving long-term therapy for OPC. The purpose of this study was to evaluate CDR1, CDR2, MDR1, and ERG11 gene expression in C. albicans clinically isolated from HIV-infected patients in Iran.
  
  
  METHODS
  In this study, we evaluated the molecular mechanisms of azole resistance in 20 fluconazole-resistant C. albicans isolates obtained from Iranian HIV-infected patients with oropharyngeal candidiasis by Real-Time polymerase chain reaction.
  
  
  RESULTS
  The overexpression of drug efflux pump CDR1 gene was found to be the major resistance mechanism observed in these isolates. The overexpression of the CDR1 gene correlated strongly with increasing resistance to fluconazole (P<0.05). Additionally, an increased level of mRNA in ERG11 was not observed in any of the tested isolates.
  
  
  CONCLUSIONS
  Our ﬁndings suggested that the CDR1 gene expression to ﬂuconazole resistance in C. albicans is greater than other known genes.
authors.affiliation: Department of Medical Parasitology and Mycology, Kerman University of Medical Sciences, Kerman, Iran; Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Kerman University of Medical Sciences, Kerman, Iran. Electronic address: sa_salari@kmu.ac.ir.
authors.forename: S
authors.initials: S
authors.lastname: Salari
authors.affiliation: Mycology Research Center, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.
authors.forename: A R
authors.initials: AR
authors.lastname: Khosravi
authors.affiliation: Department of Medical Parasitology and Mycology, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: S A A
authors.initials: SA
authors.lastname: Mousavi
authors.affiliation: Department of Microbiology and Immunology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.
authors.forename: G H
authors.initials: GH
authors.lastname: Nikbakht-Brojeni
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology*; D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000235:genetics; D000328:Adult; D000935:Antifungal Agents / Q000494:pharmacology*; D002176:Candida albicans / Q000187:drug effects* / Q000235:genetics; D002180:Candidiasis, Oral / Q000382:microbiology*; D018076:DNA, Complementary / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D025141:Drug Resistance, Fungal / Q000235:genetics; D005260:Female; D015725:Fluconazole / Q000494:pharmacology*; D005656:Fungal Proteins / Q000235:genetics; D015966:Gene Expression Regulation, Fungal; D006801:Humans; D007492:Iran; D008297:Male; D026901:Membrane Transport Proteins / Q000235:genetics; D008826:Microbial Sensitivity Tests; D010608:Pharyngeal Diseases / Q000382:microbiology*; D012331:RNA, Fungal / Q000235:genetics / Q000302:isolation & purification; D060888:Real-Time Polymerase Chain Reaction
chemical_list: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D000935:Antifungal Agents; C094693:CDR1 protein, Candida albicans; D018076:DNA, Complementary; D005656:Fungal Proteins; D026901:Membrane Transport Proteins; D012331:RNA, Fungal; D015725:Fluconazole
keywords: Azole resistance; Candida albicans; Efﬂux pumps; Fluconazole; Pompe à efflux; Résistance azolés