Vulvovaginal Candidiasis and HIV Infection
The attack rate of Vulvovaginal Candidiasis (VVC) in HIV-infected women is unknown. Vaginal Candida colonization rates in HIV-infected women are higher than among seronegative women with similar demographic characteristics and high-risk behaviors, and the colonization rates correlate with increasing severity of immunosuppression. Symptomatic VVC is more frequent in seropositive women and similarly correlates with severity of immunodeficiency. In addition, among HIV-infected women, systemic azole exposure is associated with the isolation of non-albicans Candida species from the vagina.
Based on available data, therapy for VVC in HIV-infected women should not differ from that for seronegative women. Although long-term prophylactic therapy with fluconazole at a dose of 200 mg weekly has been effective in reducing C. albicans colonization and symptomatic VVC, it is not recommended for routine primary prophylaxis in HIV-infected women in the absence of RVVC. Given the frequency with which RVVC occurs in the immunocompetent healthy population, RVVC should not be considered a sentinel sign to justify HIV testing.