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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 in HIV-positive patients suffering from oral candidiasis (mouth thrush) in Indonesia. Researchers identified the types of Candida fungi present and tested their resistance to four common antifungal medications. Most patients had Candida albicans, and while these fungi generally responded well to newer antifungal drugs like voriconazole and fluconazole, some showed resistance, particularly to fluconazole, suggesting the need for careful testing before prescribing treatment.

Background

Oral candidiasis is a common opportunistic infection in HIV-positive patients and serves as an early indicator of immunosuppression. While Candida albicans remains the primary pathogen, non-Candida albicans Candida (NCAC) species are increasingly reported, raising concerns about antifungal resistance patterns in resource-limited settings like Indonesia.

Objective

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 isolated from all samples (100%), with NCAC species including C. glabrata (10%), C. krusei (3.3%), and C. tropicalis (3.3%) also detected. Voriconazole showed the widest inhibition zone (34.0 ± 10.7 mm), followed by fluconazole (33.0 ± 9.3 mm), with 90.0% and 86.7% susceptibility respectively. Fluconazole resistance was detected in 10% of isolates, and nystatin resistance in 6.7%.

Conclusion

C. albicans remains the predominant species in HIV-positive patients with oral candidiasis. Fluconazole and voriconazole demonstrated high susceptibility, while a subset of isolates showed resistance, highlighting the emergence of antifungal resistance. Routine species identification and susceptibility testing are essential to guide therapy and monitor resistance in immunocompromised populations.
  • Published in:HIV/AIDS - Research and Palliative Care,
  • Study Type:Cross-sectional Study,
  • Source: PMID: 41169611, DOI: 10.2147/HIV.S536437
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