Is vulvovaginal candidiasis an AIDS-related illness?

Early in the AIDS epidemic, retrospective studies reported that vaginal candidiasis occurred more frequently in women who were infected with human immunodeficiency virus (HIV) than in those who were not infected. Some investigators suggested that new onset or recurrent vaginal candidiasis might identify HIV-infected individuals and predict the course of AIDS in women already known to be infected. In this article, studies of vaginal candidiasis in HIV-infected women are examined, and several observations are made. First, early studies were small and likely reflected biased populations. Second, adherence to previously accepted diagnostic criteria for vaginal candidiasis was not consistent in these studies. Finally, conclusions about the increased risk of recurrent or chronic candidal vaginitis in HIV-infected women have been promulgated in the medical literature and may have influenced clinical practice even though such statements are not supported epidemiologically. Prospective trials with uninfected community controls should determine the true impact of HIV infection on vulvovaginal candidiasis.