Assessment of Antifungal Susceptibility of Candida Species Isolated in HIV Patients with Oropharyngeal Candidiasis in Gabon

Abstract

Antifungal resistance represents a threat to public health. The widespread use of antifungals in the treatment of oropharyngeal candidiasis among HIV patients raises the risk of emergent resistant Candida species. The objective of this study was to identify Candida strains in people living with HIV and to determine their susceptibility to a range of antifungal agents in Libreville, Gabon. From April to October 2021, people living with HIV with oropharyngeal candidiasis were recruited in the Centre hospitalier universitaire de Libreville, in Gabon. Candida species strains were cultured on Chromatic Candida agar. Antifungal drug (Fluconazole, Miconazole, Ketoconazole, Miconazole, Clotrimazole and amphotericin B) susceptibility of Candida was tested according to the Clinical and Laboratory Standards Institute (CLSI) M44-A procedure. A total of 239 Candida sp. isolates were collected from HIV patients. C. albicans was the most frequent species (55.2%). Among non-albicans Candida species (n=107/239, 44.8%), C. krusei was the predominant species (n=52; 21.8%), followed by C. dubliniensis (n=25/239, 10.5%). C. albicans species exhibited resistance to fluconazole (58.4%) and miconazole (68.5%) in more than half of the isolates. Over 60% of C. dubliniensis isolates also showed resistance to fluconazole and to ketoconazole. The present study highlights a significant prevalence of non-albicans Candida as the cause of oropharyngeal candidiasis in Gabonese HIV-infected patients and a significant proportion of Candida sp. resistant strains.