Antifungal Susceptibility Patterns in Respiratory Tract Candidiasis and Risk Factors Among HIV-Infected Adults in South West Cameroon

Background: Respiratory tract candidiasis, primarily caused by Candida species, is a prevalent opportunistic fungal infection in individuals with HIV/AIDS. A high HIV viral load is considered a significant risk factor for developing respiratory fungal infection. This study aimed to identify the yeast species isolated from sputum samples of HIV-positive and HIV-negative adults, determine their antifungal susceptibility patterns, and investigate associated risk factors. Methods: A hospital-based comparative cross-sectional study was conducted from March to May 2022. Sputum samples were collected from 190 HIV-positive and 190 HIV-negative participants. Candida and other yeast species were isolated and identified, followed by antifungal sensitivity testing. Results: Of the 190 specimens from each group, 77 (40.53%) from HIV patients and 12 (6.31%) from HIV-negative participants tested positive for yeasts. Candida albicans was the most prevalent species, found in 52 (67.53%) HIV-positive patients and 12 (100%) HIV-negative patients. This was followed by Nakaseomyces glabratus (15.58%), Pichia kudriavzevii (9.09%), Candida tropicalis (6.49%), and Candida parapsilosis (1.29%) in HIV-positive patients. Notably, all 12 isolates from HIV-negative participants demonstrated 100% sensitivity to all ten tested antifungal drugs. In contrast, isolates from HIV patients showed significant resistance to fluconazole and ketoconazole (32.5% each). High viral load (p < 0.001), dermatophyte infection (p < 0.001), and antiretroviral (ARV) regimen (p = 0.030) were significantly associated with respiratory tract fungal infections in HIV patients. Conclusions: Based on this exploratory study, respiratory mycosis is frequent in HIV-positive patients in Cameroon, and identified fungi show increased resistance to azoles. While these results must be interpreted with care due to the sample size relative to the high national HIV prevalence, they suggest that public health education is needed to improve awareness. These preliminary findings prompt a review by health authorities concerning the use of fluconazole for prophylaxis in HIV-positive patients in Cameroon.