Declining rates of oropharyngeal candidiasis and carriage of Candida albicans associated with trends toward reduced rates of carriage of fluconazole-resistant C. albicans in human immunodeficiency virus-infected patients.

In order to determine the current prevalence and incidence of fluconazole-resistant oropharyngeal candidiasis among human immunodeficiency virus (HIV)-infected patients, we conducted a prospective observational study of a consecutive series of HIV-infected patients. Of 128 enrolled patients, 70 patients completed four quarterly follow-up visits over a period of 1 year. Over this period, declining rates of carriage of Candida albicans (from 61% to 39%; P = .008) and of oropharyngeal candidiasis (from 30% to 4%; P < .001) were documented. Trends toward reduction in the frequency of fluconazole-resistant isolates (MIC, > or = 64 micrograms/mL) were also seen. During the survey period, the mean (median) number of antiretroviral agents used per patient rose from 0.5 (0) to 1.8 (2) (P < .001). Thus, rather than progression, we observed declining rates of oropharyngeal candidiasis, C. albicans carriage, and fluconazole-resistant C. albicans in a cohort of HIV-infected patients treated with increasingly effective antiretroviral therapy.