638. Epidemiology and Risk Factors for Fluconazole Resistant Oral Yeasts in the Era of Antiretroviral Therapy (ART)
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:  As ART becomes increasingly prevalent and HIV is addressed as a chronic disease, the impact on opportunistic infections including oropharyngeal candidiasis (OPC) continues to evolve.  The epidemiology of oral yeast colonization and OPC in the era of ART are not well established.

Methods:  215 HIV/AIDS patients with a CD4+ count <200/mm3 and/or symptomatic OPC were enrolled in a prospective longitudinal observational study.  Yeast colonization was assessed from oral rinse and swabs.  Preliminary species identification was made using CHROMagar Candida and confirmed with microbiological techniques and/or molecular sequencing.  Fluconazole (FLC) resistance screening was conducted with a CHROMagar Candida-based agar dilution method. We assessed demographics and risk factors for yeast colonization and OPC including the impact of age, gender, years since HIV/AIDS diagnosis, tobacco use, denture use, CD4+ count, HIV viral load, and previous anti-fungal use.

Results:  176 (82%) patients were colonized with oral yeasts at baseline and 59 (27%) patients had OPC.  Candida albicans was the most prevalent species in colonized pts 60% (137/228) and diseased 88% (52/59) patients.  C. glabrata was detected in 16% colonized and 29% of OPC patients, with C. dubliniensis seen in 11% and 10%, respectively. Decreased FLC susceptibility (MIC > 8 µg/ml) occurred in 45/176 (26%) patients with positive cultures. 58/59 (98%) OPC patients had favorable responses to FLC.  The risk of FLC-resistant yeast was increased with previous anti-fungal use (OR 2.9, p =0.006) and denture use (OR 3.39, p=0.008).

Conclusion:  Oral yeast colonization and OPC remain common even with advances in HIV therapy.  C. albicans was most frequently isolated, but non-albicans yeast made up 40% of isolates and may be resistant to FLC. Previous antifungal use and denture use increased the risk of FLC resistant yeasts. 


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Payal K. Patel , Medicine / Infectious Diseases, UTHSCSA and STVHCS, San Antonio, TX
Josh E. Erlandsen , Medicine / Infectious Diseases, UTHSCSA and STVHCS, San Antonio, TX
William R. Kirkpatrick , Medicine / Infectious Diseases, UTHSCSA and STVHCS, San Antonio, TX
George R. Thompson III, MD , Medical Microbiology and Immunology, University of California-Davis, Davis, CA
Monica L. Herrera , Medicine / Infectious Diseases, UTHSCSA and STVHCS, San Antonio, TX
Deborah K. Berg , Medicine / Infectious Diseases, UTHSCSA and STVHCS, San Antonio, TX
Steven D. Westbrook , Medicine / Infectious Diseases, UTHSCSA and STVHCS, San Antonio, TX
Brian L. Wickes , Medicine / Infectious Diseases, UTHSCSA and STVHCS, San Antonio, TX
Nathan P. Wiederhold , Medicine / Infectious Diseases, UTHSCSA and STVHCS, San Antonio, TX
Spencer W. Redding , Medicine / Infectious Diseases, UTHSCSA and STVHCS, San Antonio, TX
Thomas F. Patterson, MD , Medicine/Infectious Diseases, University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, TX

Disclosures:

P. K. Patel, None

J. E. Erlandsen, None

W. R. Kirkpatrick, None

G. R. Thompson III, None

M. L. Herrera, None

D. K. Berg, None

S. D. Westbrook, None

B. L. Wickes, None

N. P. Wiederhold, Yes
Pfizer: Grant Investigator,
Merck: Grant Investigator,
Basilea: Grant Investigator,

S. W. Redding, None

T. F. Patterson, Yes
Pfizer: Consultant, Grant Investigator and Scientific Advisor,
Merck: Grant Investigator and Scientific Advisor,
Basilea: Consultant, Grant Investigator and Scientific Advisor,

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