Immune compromise and prevalence of Candida vulvovaginitis in human immunodeficiency virus-infected women

Objective: To investigate the effect of human immunodeficiency virus (HIV) infection on vaginal yeast colonization and symptomatic vulvovaginitis and to explore the effects of immune compromise on these conditions in HIV- positive women. Methods: Between September 1991 and May 1993, 223 HIV- positive women without AIDS-defining conditions were enrolled for prospective follow-up and compared with 289 HIV-negative women enrolled in a concurrent study. Standardized gynecologic assessment was carried out. Results: Cultures from 81 of 223 (36%) HIV-positive women and 72 of 289 (25%) HIV-negative women were positive for any yeast. The most commonly isolated yeasts were Candida albicans and Torulopsis glabrata; the proportion of non-C albicans isolates (26%) did not differ by serostatus. The rates of C albicans colonization and vulvovaginitis among immunocompetent (CD4 count at least 500 cells/mm³) HIV-positive women did not differ from those among HIV-negative women. Among HIV-positive women, risks for colonization and for symptomatic vulvovaginitis were increased approximately threefold and fourfold, respectively, in women with CD4 counts below 200 cells/mm³ compared with either immunocompetent HIV-positive women or HIV-negative women. Conclusion: The yeast species isolated from HIV-positive and HIV-negative women were similar. Rates of vaginal colonization and vaginitis were similar among nonimmunocompromised HIV-positive women and HIV-negative women. Elevated rates of yeast colonization and vaginitis were not seen among this population of HIV-infected women before immune compromise. Both vaginal colonization and symptomatic vaginitis increased with immune compromise among HIV-positive women, especially at CD4 counts below 200 cells/mm³.