Study: Candida vaginitis not a sign of early HIV
Study: Candida vaginitis not a sign of early HIV
Reducing sugar in the diet may help prevent CV
A new study indicates that candida vaginitis (CV) is not an early marker for HIV infection among women, but it is an indication that an HIV-infected woman’s immune system is declining.1
Ann B. Williams, EdD, RN-C, professor at Yale University School of Nursing in New Haven, CT, and colleagues conducted a cross-sectional analysis of the factors associated with the isolation of yeast from vaginal swabs and a clinical diagnosis of CV among 184 women with HIV. The study was conducted in 1995 and 1996.
Only 52% of the women were taking antire troviral therapy. Williams says she and her co-investigators referred women who were not on antiretroviral therapy to area AIDS providers. Sixty-four (35%) of the women had positive vaginal swabs for yeast, and 19 (10%) met all of the following criteria for the case definition for CV:
• presence of vaginal pruritis or discharge reported by the patient or discharge observed by the examining clinician;
• observation of spores or hyphae on a potassium hydroxide or saline microscopic preparation of vaginal discharge;
• the presence of candida species cultured from a vaginal swab.
Of 107 women who were asked at the beginning of the study whether they currently had a yeast infection, 34 answered yes, although only four of these women met the criteria for clinical diagnosis of CV. Conversely, 15 women who did not believe they had a yeast infection when they were examined actually did have CV.
Ten percent of all the women (19) in the study were diagnosed with CV, compared to 20% of women with low CD4 counts (100 cells/mm3).
Williams says it is particularly important to advise women with HIV to take steps to prevent CV, such as not wearing tight-fitting pants or underwear, only wearing cotton underwear, wiping from front to back after using the bathroom, avoiding douching, and using only unscented tampons or pads. There is some evidence that reducing the amount of sugar in the diet may help prevent CV as well, she adds.
She also advises HIV-infected women to receive regular gynecologic evaluations at least once a year. They should be instructed that if they develop symptoms of CV and decide to treat it with over-the-counter products, they should contact their clinician if their symptoms do not resolve quickly. A systemic medication such as fluconazole (Diflucan) may be necessary.
"There’s no reason to believe candida should be treated any differently between HIV-positive and HIV-negative women," Williams says. "However, when women have very advanced HIV disease with very low CD4 counts, it is possible that the candida will be more difficult to treat or more recurrent. But generally speaking, when people have CD4 counts under 100, you’re going to be looking at a variety of ways to deal with their vulnerability to opportunistic infections and fungal infections as well. At that point, you’re thinking not only about candida vaginitis, but also esophagitis and other candidal [infections]."
Reference
1. Williams AB, Andrews S, Tashima K, et al. Factors associated with vaginal yeast infections in HIV-positive women. J Assoc Nurses AIDS Care 1998; 9:47-52.
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