Determinants of incident vulvovaginal candidiasis in human immunodeficiency virus-positive women.

OBJECTIVE Mucosal infections including vulvovaginal candidiasis are a common problem for women with human immunodeficiency virus (HIV) infection. Our objective was to determine which factors predict the development of symptomatic disease among HIV-infected women. MATERIALS AND METHODS In a prospective study from 1991 to 1995, 205 HIV-positive women were evaluated every 6 months for occurrences of vulvovaginal candidiasis. Included in the study were all initially asymptomatic women, whether they were fungal-culture-positive or -negative at baseline. Excluded from the study were all women with symptomatic vulvovaginal candidiasis at the initial visit, those who developed trichomonas vaginitis at any visit, and those who used any antifungal agents. RESULTS The risk of the development of vulvovaginal candidiasis did not differ between women who were asymptomatically colonized at baseline and those who were fungal-culture-negative. However, the risk of developing vulvovaginal candidiasis was increased 6.8 times for women with CD4 counts less than 200 cells/mm3 at baseline. CONCLUSIONS Fungal culture is not predictive of the development of symptomatic vulvovaginal candidiasis. Women infected with HIV who have CD4 counts below 200 cells/mm3 should be monitored more carefully for vulvovaginal candidiasis.