Human immunodeficiency virus and Candida albicans co-infection in Iran: a systematic review

Candidiasis is one of serious problems in immunosuppressed patients, including HIV patients. Can- dida albicans is a fungi causing different humans diseases. Immunosuppression is a hallmark of HIV infection, and its' deficiency can introduce complications through impairment of immune cells, such as CD4+ lymphocytes.The aim of the current review was to investigate the importance of candidiasis co-infection in HIV Iranian patients. In addition, it focused on prognosis, prevention, and management of candidiasis since this infection could have a large scale of mortality in people living with HIV and AIDS (PLWHA).For the current systematic review, multiple electronic bibliographic databases were searched, including PubMed, EMBASE, Scopus, Web of Science, Google Scholar, and Iranian databases from 1 January 2011 until 24 February 2020.Majority of articles (n = 11) investigated oral and oropharyngeal candidiasis (OPC) with a prevalence range of 16.5% to 43.82% in HIV-positive patients. Apart from oral candidiasis, one reference also evaluated vagina, nail, and skin candidiasis. C. albicans isolates were the most prevalent species, with a 34.42%, 52.2%, and 82.2% frequency rate in three studies, while in other papers, there was a fluctuation in C. albicans prevalence. Candidiasis is the most prevalent opportunistic infection in AIDS patients. Due to high prevalence rate of oropharyngeal candidiasis, routine screening of HIV patients is recommended. Since CD4+ T cells count decreased in HIV patients, periodic examinations are necessary. Fluconazole is most commonly used azole to treat Candida due to its mechanism; however, anti-fungal prophylaxis needs more investigation to reduce mortality and morbidity associated with mucosal candidiasis.