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Evaluation of Antifungal Activity Against Candida albicans Isolates From HIV-Positive Patients with Oral Candidiasis in a Major Referral Hospital, West Java, Indonesia

Summary

This study examined fungal infections of the mouth in HIV-positive patients in Indonesia. Researchers identified different types of Candida fungi and tested how well common antifungal medications worked against them. While most medications were effective, they found some cases of drug resistance, suggesting the importance of proper testing to choose the best treatment for each patient.

Background

Oral candidiasis is a common opportunistic fungal infection in HIV-positive patients and serves as an early clinical indicator of immunosuppression. While Candida albicans remains the primary pathogen, non-Candida albicans Candida (NCAC) species have emerged with increasing antifungal resistance, particularly to azole-based therapies. Local epidemiological data on Candida species and antifungal resistance patterns in Indonesia remain limited.

Objective

This study aimed to identify Candida species in HIV-positive patients with oral candidiasis and assess the antifungal susceptibility of the predominant species to commonly used antifungal agents including nystatin, fluconazole, itraconazole, and voriconazole.

Results

Candida albicans was identified in 100% of samples with a median count of 270 CFU/mL. NCAC species were also detected including C. glabrata (10%), C. krusei (3.3%), and C. tropicalis (3.3%). Voriconazole demonstrated the widest inhibition zones (34.0 ± 10.7 mm), followed by fluconazole (33.0 ± 9.3 mm), with 90% and 86.7% susceptibility respectively, while fluconazole and voriconazole resistance was detected in 10% and 13.3% of isolates respectively.

Conclusion

C. albicans remains the predominant species in oral candidiasis among HIV-positive patients, with fluconazole and voriconazole showing high susceptibility rates. However, emerging resistance to these agents was detected in a subset of isolates, highlighting the importance of routine species identification and antifungal susceptibility testing to guide therapy and monitor resistance in immunocompromised populations.
  • Published in:HIV/AIDS - Research and Palliative Care (PMC),
  • Study Type:Cross-sectional study,
  • Source: PMID: 41169611, DOI: 10.2147/HIV.S536437
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