ORAL CANDIDIASIS IN HIV AND CANCER PATIENTS: REVIEW OF EPIDEMIOLOGY, PATHOGENESIS AND MANAGEMENT

Abstract

Background: Oral candidiasis is a common opportunistic fungal infection affecting immunocompromised individuals, particularly patients with Human Immunodeficiency Virus (HIV) infection and those undergoing cancer therapy. Despite advances in antiretroviral and oncologic treatments, the condition remains prevalent due to immune suppression, mucosal barrier damage, and emerging antifungal resistance. Increasing reports of non-albicans Candida species further complicate clinical management. Objective: This study aimed to comprehensively review the epidemiology, pathogenesis, species distribution, antifungal resistance patterns, and management strategies of oral candidiasis in HIV-infected and cancer patients. Methods: A narrative literature review was conducted using electronic databases including PubMed, Scopus, Web of Science, and Google Scholar. Peer-reviewed articles published between 2018 and 2025 were included. Studies focusing on prevalence, risk factors, Candida species identification, antifungal susceptibility, and treatment outcomes in HIV and cancer populations were critically analyzed and synthesized. Results: The review revealed high prevalence rates of oral candidiasis in both HIV and cancer patients, strongly associated with CD4+ T-cell depletion, neutropenia, mucositis, and xerostomia. Candida albicans remained the predominant species; however, a growing proportion of non-albicans species demonstrated reduced susceptibility to azole antifungals. Antifungal resistance, recurrent infections, and biofilm formation were identified as major therapeutic challenges. Conclusion: Oral candidiasis continues to be a clinically significant complication in immunocompromised populations. Early diagnosis, species-level identification, susceptibility-guided therapy, and preventive oral healthcare strategies are essential to reduce morbidity and improve patient outcomes.