Biotypes of oral Candida albicans isolated from AIDS patients and HIV-free subjects in Thailand

Effect of efavirenz on the pharmacokinetics of ketoconazole in HIV-infected patients

OBJECTIVE

To investigate the effect of efavirenz on the ketoconazole pharmacokinetics in HIV-infected patients.

METHODS

Twelve HIV-infected patients were assigned into a one-sequence, two-period pharmacokinetic interaction study. In phase one, the patients received 400 mg of ketoconazole as a single oral dose on day 1; in phase two, they received 600 mg of efavirenz once daily in combination with 150 mg of lamivudine and 30 or 40 mg of stavudine twice daily on days 2 to 16. On day 16, 400 mg of ketoconazole was added to the regimen as a single oral dose. Ketoconazole pharmacokinetics were studied on days 1 and 16.

RESULTS

Pretreatment with efavirenz significantly increased the clearance of ketoconazole by 201%. C(max) and AUC(0-24) were significantly decreased by 44 and 72%, respectively. The T ((1/2)) was significantly shorter by 58%.

CONCLUSION

Efavirenz has a strong inducing effect on the metabolism of ketoconazole.

Oral Candida species and betel quid-associated oral lesions in Padaung women of Northern Thailand

Purpose of the present investigation was to study the association between the betel quid chewing (BQC) habits, the oral yeast flora and oral lesions in female Padaung of northern Thailand. Oral swabs were taken from the tongue and palate of 50 Padaung women with and 50 control individuals without BQC habit. The spectrum of oral Candida species in both groups was determined microbiologically. In addition, oral mucosal lesions were registered in both groups. Mean age of BQ chewers was 35.4 years, of non-chewers was 19.2 years. Candida parapsilosis was the most common Candida spp. isolated both in BQ chewers (46%) and non-chewers (44%). Candida albicans was revealed in 24% of BQ chewers and 18% of non-chewers. There was no significant difference in carriage of Candida spp. isolated between both groups. Forty-four per cent of BQ chewers revealed betel chewers mucosa, 10% showed leukoedema. Isolated populations such as the Padaung may reveal different patterns of candidal flora, in this case a predominance of Candida parapsilosis.

Oral candidosis and associated Candida species in HIV-infected Cambodians exposed to antimycotics

Although human immundeficiency virus (HIV) infection is endemic in Southeast Asia, data on oral mycotic flora in this disease in Asians are sparse. The aim of this study was to determine the prevalence of Candida species in HIV-infected Cambodians with oral candidosis, unexposed (group 1) and exposed to antimycotics (group 2) and a healthy population (group 3). In 161 HIV patients with oral candidosis (group 1: 121 pts; group 2: 40 pts) and in 81 controls (group 3) swab samples of tongue and palate were obtained. Oral candidosis was detected in 100 and 70% of groups 1 and 2 respectively. Candida spp. were isolated from 91 and 100% of groups 1 and 2, respectively, and from 79% of controls. Candida albicans was the most common, with non-albicans species such as C. tropicalis and C. krusei being notable. Our data indicate that variants of oral candidal infections in HIV disease are similar to those seen in the pre-HAART era. The particularly high rate of C. krusei isolation in all groups is noteworthy.

Genotype of Candida species associated with different conditions of vulvovaginal candidosis

It is unknown whether strains isolated from recurrent vulvovaginal candidosis (RVVC), vulvovaginal candidosis (VVC) and asymptomatic carriers are varying or not in genotyping. Candida isolates were genotyped to determine whether specific types were associated with RVVC and VVC. A total of 97 Candida isolates from RVVC patients (n = 43), from VVC patients (n = 47) and asymptomatic carriers (n = 7) were identified by germ tube test, chlamydospore test, CHROMagar Candida and API20 system and were genotyped by polymerase chain reaction (PCR) fingerprinting employing random amplification of polymorphic DNA (RAPD) assay with nine random primers screened. The RAPD identified distinct genotypes that were shared among isolates from most different individuals. Most of the 85 C. albicans strains failed to corroborate any obvious differences in the genotypic variability in the VVC, RVVC patient groups and carriers by clustering analysis. Only a few individuals were found to harbor a distinct genotype of C. albicans isolates associated with a specific disease condition.

PCR fingerprinting of Candida albicans associated with chronic hyperplastic candidosis and other oral conditions

The purpose of this study was to genotype strains of Candida albicans to determine whether specific types were associated with chronic hyperplastic candidosis (CHC). A total of 67 candidal isolates from CHC patients (n = 17) and from patients with other oral conditions (n = 21) were genotyped by PCR fingerprinting employing two interrepeat primer combinations (1245 and 1246 primers or 1251 primer) and a single minisatellite-specific M13 primer. The most suitable primer for fingerprint analysis was found to be primer 1251, yielding well-resolved banding patterns. For the 67 isolates tested, PCR fingerprinting delineated 25 (1245 and 1246 primers), 27 (1251 primer), and 25 (M13 primer) profiles. The majority of C. albicans isolates from multiple sites within the mouth produced identical profiles (six out of nine subjects examined). For patients for whom a series of longitudinal isolates was available, strain persistence for up to 7 years was evident for five out of eight individuals, despite episodes of antifungal therapy. Computer-assisted comparison of the interrepeat PCR fingerprints identified seven distinct profiles that were shared among isolates from different individuals. However, no association was evident among isolates of C. albicans from specific clinical conditions. Eight isolates that were initially identified as C. albicans but having atypical PCR profiles were later confirmed as Candida dubliniensis. In conclusion, the genotypic data do not indicate clonal restriction of C. albicans with respect to CHC. Furthermore, these results have demonstrated that in the majority of individuals, colonizing populations of C. albicans are clonal in nature and exhibit strain persistence.