Low level of antifungal resistance in Candida species recovered from Iranian HIV-associated oral infection

• Published in: Letters in applied microbiology Vol. 76; no. 3
• Main Authors: Erfaninejad, Maryam, Zarei Mahmoudabadi, Ali, Maraghi, Elham, Hashemzadeh, Mohammad, Fatahinia, Mahnaz
• Format: Journal Article
• Language: English
• Published: England 01.03.2023
• Subjects: Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; Candida; Candidiasis, Oral - drug therapy; Drug Resistance, Fungal; Fluconazole - therapeutic use; HIV Infections - complications; Humans; Iran - epidemiology; Microbial Sensitivity Tests; Iran; CLSI; antifungal; HIV; Iran; Candida; AIDS; oral; candidiasis
• ISSN: 1472-765X; 1472-765X
• DOI: 10.1093/lambio/ovad029

Oral candidiasis (OC) is the most frequent opportunistic fungal infection, which is a predictive indicator of immunosuppression and disease progression among people living with HIV/AIDS (PLWHA). In the present study, 109 Candida isolates were collected from 94 PLWHA afflicted with oral Candida infection (OCI) following highly active antiretroviral therapy (HAART). The susceptibility profiles of Candidaspp. to six antifungal agents were evaluated using CLSI broth microdilution. The prevalence of OCI was 34.06%. The susceptibility profile of Candidaspp. revealed 100% sensitivity to caspofungin, while 6.4%, 5.4%, 24.5%, and 2.8% of Candida isolates showed resistance or nonwild-type MICs to fluconazole, itraconazole, posaconazole, and amphotericin B, respectively. Notably, 15.9% of patients and 3.7% of isolates showed mixed Candida infections and multidrug resistance, respectively. The low-level resistance to antifungal agents observed in the present study may be explained by the fact that none of the participants had prior and prolonged exposure to these antifungals. However, more focus should be placed on the mechanisms of reduced susceptibility and low-level resistance in Candida species since they can serve as stepping stones to developing clinical resistance. Alongside this, it seems a must to understand the local epidemiology of Candida spp. and their susceptibility pattern.