Are Candida albicans isolates from people living with HIV more resistant to antifungals? A systematic review and meta-analysis

People living with HIV (PLHIV) often require antifungal medications for the treatment or prevention of infections, which may contribute to the emergence of resistant Candida albicans strains. This systematic review aimed to investigate whether the prevalence of antifungal resistance in C. albicans isolates from the oral and oropharyngeal cavities is higher in PLHIV compared to HIV-uninfected individuals. The research question was structured using the Population (P), Exposure (E), Comparator (C), and Outcome (O) strategy: (P) PLHIV and HIV-uninfected individuals; (E) HIV infection; (C) HIV-uninfected individuals; (O) Prevalence of antifungal-resistant C. albicans. The protocol was registered in PROSPERO (CRD42022350141). A search was conducted across five databases (PubMed, EMBASE, Scopus, LiVivo, Lilacs, Web of Science) and Google Scholar, including studies published up to May 2024. Two independent reviewers performed screening, data extraction, and quality assessment using the Joanna Briggs Institute tool. Meta-analyses for each antifungal were conducted using fixed-effect models and the Peto’s method. Out of 5425 records, 13 studies from nine countries were included in the meta-analysis. The analysis revealed higher fluconazole resistance in PLHIV. For a minimum inhibitory concentration (MIC)Aÿ>Aÿ8AÿI¬g/mL, the odds ratio (OR) was 3.53 (CI: 1.29-2.40; p: 0.029). For MIC >64AÿI¬g/mL, the OR was 2.33. Resistance to other antifungals (itraconazole, voriconazole, ketoconazole, nystatin, amphotericin B, and flucytosine) was similar between groups. Low heterogeneity indicated consistent results across studies. In conclusion, fluconazole resistance is significantly higher in PLHIV, likely due to prolonged use, while other antifungals remain effective treatment options for both populations studied

• Population(s)
  • General HIV+ population
• Co-infections
  • Other