Candidal infections occur frequently in patients with HIV.¹⁰⁰ These infections are often a worrisome sign of immunosuppression and signify the need to initiate Pneumocystis prophylaxis. In resource-poor settings—especially those without CD4 monitoring capacity—candidal infections may also signify the need to start ART.

The oropharynx and esophagus are common sites of candidal infection. Patients often present with whitish plaques and difficult or painful swallowing.^101,102 For women with HIV, vulvovaginal candidiasis can be quite severe, often presenting with vaginal discharge and itching; please refer to Section 2.6.3 and Protocol 2.7.¹⁰³

Candida albicans is the most common cause of candidal infections, although in patients with HIV the non-albicans species—which may be resistant to common antifungal agents—are more common.¹⁰⁴ An approach to managing oral and esophageal candidal infections is summarized in Protocol 3.22.