Molecular identification and antifungal susceptibility profiles of etiologic agents of oral candidiasis among HIV-positive patients: A multicenter study

Background and Purpose: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a serious risk factor for oral candidiasis (OC). In this regard, the present study aimed to investigate the frequency of Candida species collected from the oropharyngeal cavity of HIV-positive patients and the sensitivity of these isolates to antifungal drugs.Materials and Methods: Oral samples were collected from ۱۶۹ HIV-positive patients. In addition to culture-based methods, a molecular assay via the polymerase chain reaction restriction fragment length polymorphism method was applied to identify isolates using the MspI restriction enzyme. The disk diffusion method determined the susceptibility of isolated yeasts to common antifungal drugs according to the CLSI M۴۴-A۲ protocol.Results: In total, ۸۱ participants (۴۷.۹۲%) were positive for OC, and Candida albicans was the most prevalent yeast (۵۳.۹۸%). The median age of patients was ۳۶ years old (IQR=۱۰.۵; ۱۷-۵۹), and it was found that women are ۲۷% more susceptible to HIVassociated OC (OR=۱.۲۶۸; ۹۵% CI: ۰.۶۸۵-۲.۳۴۸). Patients who received antifungal therapy had a ۹۷.۳% reduced chance for OC (OR: ۰.۰۲۷; ۹۵% CI: ۰.۰۰۸-۰.۰۹۱; P-value: ۰.۰۰۰). Antifungal therapy reduced the risk of OC by ۹۷.۳% (OR=۰.۰۲۷; ۹۵% CI=۰.۰۰۸- ۰.۰۹۱; P=۰.۰۰۰), and antiretroviral therapy decreased the chance of OC ۴.۴۲ times (OR=۴.۴۲۳; ۹۵% CI=۱.۶۹۷-۱۱.۵۲۸; P=۰.۰۰۲). The resistance rates for antifungals, namely fluconazole, ketoconazole, itraconazole, amphotericin B, and nystatin were ۱۵.۹۳%,۸.۸۵%, ۷.۹۶%, ۵.۳۱%, and ۴.۴۲%, respectively.Conclusion: Although several decades have passed since the emergence of HIV/AIDS,little information is available about fungal colonization and infections in this population. Further investigations are suggested using novel and reference molecular identification methods, such as matrix-assisted laser desorption ionization time-of-flight mass spectrometry and sequencing, respectively. In addition, more reliable methods for antifungal susceptibility testing are recommended.

Keywords:

drug resistance , HIV , Oral candidiasis , RFLP