Identification & Correlation of Candida Strains with CD4+ Count Among HIV Patients on HAART and Evaluation of In-Vitro Susceptibility to Fluconazole and Voriconazole

Abstract

Background: HIV is a life-threatening disease that increases morbidity and mortality due to the alterations of the body's immune system, leading to several opportunistic infections due to the progressive loss of CD4+ T lymphocytes. Aim: To identify and correlate the Candida strains with CD4+ count in Human Immunodeficiency Virus (HIV) patients on Highly active antiretroviral therapy (HAART) and evaluate the in-vitro susceptibility to fluconazole and voriconazole. Materials and Methods: A total of 100 HIV-positive patients who were not under HAART therapy were examined at three different intervals for the presence of Candida strains along with their CD4+ count and evaluated for in-vitro susceptibility to fluconazole and voriconazole. The obtained values were analyzed using the Spearman correlation test and Chi-square tests with a significant P value of 0.005 and SPSS version 20.0 software. Results: C. albicans was the most common species isolated, followed by C. krusei, C. glabrata, and C. tropicalis. C. glabrata showed a positive correlation with CD4+ count at 6 months of HAART therapy. The variation in CD4+ count prior to HAART therapy and at 3 and 6 months of HAART therapy showed a significant increase in the CD4+ count. Antifungal susceptibility testing showed that all Candida strains were resistant to fluconazole and susceptible to voriconazole. Conclusion: The correlation of CD4+ count with Candida strains and in-vitro susceptibility of voriconazole to all the identified strains of Candida as observations from the present study suggests the need for more periodic studies among different sample populations with larger sample size.