Evaluation of Antifungal Activity Against Candida albicans Isolates From HIV-Positive Patients with Oral Candidiasis in a Major Referral Hospital, West Java, Indonesia

Abstract

Purpose: Oral candidiasis remains prevalent in HIV patients, with growing concern over antifungal resistance. This study aimed to identify Candida species in HIV patients with oral candidiasis and assess the antifungal susceptibility of the predominant species. Materials and Methods: A cross-sectional study was conducted at a referral hospital in West Java, Indonesia, involving 30 HIV patients aged ≥18 years, with no prior antifungal therapy and a confirmed diagnosis of oral candidiasis. Oral rinse samples were collected and cultured on CHROMagar Candida for species identification and CFU/mL quantification. Antifungal activity was assessed using disk diffusion against nystatin, fluconazole, itraconazole, and voriconazole. Inhibition zone diameters were recorded, while categorical susceptibility interpretation was applied only to fluconazole and voriconazole based on CLSI guidelines. The Friedman test and Fisher’s exact test were used, with p < 0.05 considered statistically significant. Results: Candida (C). albicans was the predominant species (100%), consistent with previous findings. Non-Candida albicans Candida (NCAC) species, including C. glabrata (10%), C. krusei (3.3%), and C. tropicalis (3.3%), were also identified, aligning with reports of emergence. Inhibition zone diameters varied significantly (p < 0.001). Voriconazole had the widest zone (34.0 ± 10.7 mm), followed by fluconazole (33.0 ± 9.3 mm), itraconazole (29.5 ± 5.5 mm), and nystatin (27.9 ± 5.0 mm). For fluconazole and voriconazole, categorical interpretation showed 90.0% and 86.7% susceptibility, respectively, with no significant difference (p = 1.00). Since no interpretive breakpoints exist for nystatin and itraconazole, only inhibition zone diameters were reported. Conclusion: C. albicans predominated, with fluconazole and voriconazole showing high susceptibility, while nystatin and itraconazole demonstrated inhibition zones but could not be categorically interpreted due to the absence of established breakpoints. Routine species identification and susceptibility testing remain essential to guide therapy and monitor emerging resistance in immunocompromised populations, highlighting the need for further validation studies.