Candida albicans resistance in AIDS

Oral candidosis is the commonest opportunistic infection seen in patients who are immunocompromised as a result of HIV infection. Initially, systemic antifungal therapy with ketoconazole was widely used, but recently this imidazole has been superceded in many centres by the triazoles, fluconazole and itraconazole. Reasons for this include the poor absorption of ketoconazole in the presence of achlorhydria, which is common in advanced HIV disease, and the rare association of this drug with fatal hepatotoxicity. However, we now report the isolation of fluconazole-resistant, ketoconazole-sensitive Candida albicans occurring in an AIDS patient with oesophageal candidosis.