Journal Article

Evolution of Vaginal <i>Candida</i> Species Recovered from Human Immunodeficiency Virus-Infected Women Receiving Fluconazole Prophylaxis: The Emergence of <i>Candida glabrata?</i>

Jose A. Vazquez, Jack D. Sobel, Grace Peng, Lynn Steele-Moore, Paula Schuman, William Holloway and James D. Neaton

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 28, issue 5, pages 1025-1031
Published in print May 1999 | ISSN: 1058-4838
Published online May 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/514746
Evolution of Vaginal Candida Species Recovered from Human Immunodeficiency Virus-Infected Women Receiving Fluconazole Prophylaxis: The Emergence of Candida glabrata?

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The effect of fluconazole prophylaxis on the vaginal flora of 323 human immunodeficiency virus-infected women was evaluated in a multicenter, randomized, double-blind, placebo-controlled trial. Women with CD4 cell counts of ⩽300/mm3 received either 200 mg of fluconazole per week or placebo. Vaginal surveillance cultures were performed every 3 months. After a follow-up of 29 months, Candida albicans was recovered from 53% of patients receiving fluconazole and 68% of patients assigned placebo. Fluconazole was associated with a 50% reduction in the odds of being colonized with C. albicans but with higher rates for non-albicans Candida species. Candida glabrata was recovered from 40 women assigned fluconazole and 29 assigned placebo (relative odds, 1.96; 95% confidence interval, 0.98–3.94). Fluconazole had an early and persistent effect on the vaginal mycoflora, with the emergence of C. glabrata vaginal colonization within the first 6 months. The effect of fluconazole prophylaxis can be attributed to the reduction in vaginal C. albicans colonization; however, C. glabrata colonization rapidly supervened.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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