TheCandidayeast itself is present in most human beings, within the natural flora of the mouth and digestive tract, as well as on the skin.It is only when changes to these systems occur thatCandidacan actively thrive, usually manifesting with superficial infection.
However, when the immune system is severely compromised, as can happen with untreated HIV,Candidacan become invasive and spread throughout the body, causing severe illness and possibly death.Learn more about how this fungal infection can affect you and what you can do to lower your risk.
Candidiasis Symptoms
While less commonly seen,Candidainfections can also occur on the skin; under the fingernails or toenails; on the rectum,anus, orpenis; or within theesophagusor pharynx.
Candidaplaque can be scraped off from the tongue, walls of the mouth, or walls of the vagina, revealing a sore, red, denuded patch underneath. The plaque is entirely odorless.
Verywell / Emily Roberts
Candidiasis in HIV Infection
Because an active HIV infection depletes an individual’s immune response, candidiasis is commonly noted in people living with the virus.
While it can present superficially even in those on antiretroviral therapy (ART), it is most frequently noted in people with severely compromised immune systems and often serves as a warning sign for the development of more serious HIV-related illnesses.
When an HIV infection is left untreated, and a person’sCD4 countdips beneath 200 cells/milliliter (one of the official classifications ofAIDS), the risk of invasive candidiasis is profoundly increased. As a result, candidiasis of the esophagus, bronchi, trachea or lungs (but not the mouth) is today classified as anAIDS-defining condition.
Types of Candidiasis
Candidiasis can present in any number of ways: on mucosal tissues, on the skin (cutaneous), or invasively throughout the entire body. There are further classifications for mucosal and invasive types:
Mucosal candidiasis:
Invasive candidiasis:
Treatment and Prevention
TheCandidainfection itself is most commonly treated with antifungal drugs such as fluconazole, topical clotrimazole, topical nystatin, and topical ketoconazole.Oral candidiasis usually responds well to topical treatments, although oral drugs can also be prescribed. (For people living with HIV, oral medications are recommended, especially if they have been diagnosed with AIDS.)
Candidal esophagitis can be treated either orally or intravenously, depending on severity, often with the use of amphotericin B in more severe cases.
A newer class of antifungals called echinocandins is also being employed in the treatment of advanced candidiasis.All four types (anidulafungin, caspofungin, micafungin, rezafungin) are administered intravenously.
Generally speaking, echinocandins offer lower toxicity and fewer drug-drug interactions, although they are more often prescribed to patients with intolerance to other antifungal drugs.
Systemic and disseminated candidiasis affecting the bones, central nervous system, eyes, kidneys, liver, muscles, or spleen are typically treated more aggressively, with oral and/or intravenous administration of antifungal drugs. Amphoterin B is another possible option.
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4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Nobile CJ, Johnson AD.Candida albicans biofilms and human disease.Annu Rev Microbiol. 2015;69:71-92. doi:10.1146/annurev-micro-091014-104330Vila T, Sultan AS, Montelongo-Jauregui D, Jabra-Rizk MA.Oral candidiasis: A disease of opportunity.J Fungi (Basel). 2020;6(1). doi:10.3390/jof6010015Buchacz K, Lau B, Jing Y, et al.Incidence of AIDS-defining opportunistic infections in a multicohort analysis of HIV-infected persons in the United States and Canada, 2000-2010.J Infect Dis. 2016;214(6):862-872. doi:10.1093/infdis/jiw085National Institutes of Health (NIH).Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Nobile CJ, Johnson AD.Candida albicans biofilms and human disease.Annu Rev Microbiol. 2015;69:71-92. doi:10.1146/annurev-micro-091014-104330Vila T, Sultan AS, Montelongo-Jauregui D, Jabra-Rizk MA.Oral candidiasis: A disease of opportunity.J Fungi (Basel). 2020;6(1). doi:10.3390/jof6010015Buchacz K, Lau B, Jing Y, et al.Incidence of AIDS-defining opportunistic infections in a multicohort analysis of HIV-infected persons in the United States and Canada, 2000-2010.J Infect Dis. 2016;214(6):862-872. doi:10.1093/infdis/jiw085National Institutes of Health (NIH).Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Nobile CJ, Johnson AD.Candida albicans biofilms and human disease.Annu Rev Microbiol. 2015;69:71-92. doi:10.1146/annurev-micro-091014-104330Vila T, Sultan AS, Montelongo-Jauregui D, Jabra-Rizk MA.Oral candidiasis: A disease of opportunity.J Fungi (Basel). 2020;6(1). doi:10.3390/jof6010015Buchacz K, Lau B, Jing Y, et al.Incidence of AIDS-defining opportunistic infections in a multicohort analysis of HIV-infected persons in the United States and Canada, 2000-2010.J Infect Dis. 2016;214(6):862-872. doi:10.1093/infdis/jiw085National Institutes of Health (NIH).Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents.
Nobile CJ, Johnson AD.Candida albicans biofilms and human disease.Annu Rev Microbiol. 2015;69:71-92. doi:10.1146/annurev-micro-091014-104330
Vila T, Sultan AS, Montelongo-Jauregui D, Jabra-Rizk MA.Oral candidiasis: A disease of opportunity.J Fungi (Basel). 2020;6(1). doi:10.3390/jof6010015
Buchacz K, Lau B, Jing Y, et al.Incidence of AIDS-defining opportunistic infections in a multicohort analysis of HIV-infected persons in the United States and Canada, 2000-2010.J Infect Dis. 2016;214(6):862-872. doi:10.1093/infdis/jiw085
National Institutes of Health (NIH).Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents.
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