# P-1924. Antifungal Resistance of Candida spp. isolates from HIV/AIDS Patients in Iran 1999-2024: A Systematic Review and Meta-analysis

## TL;DR

This study reviews antifungal resistance in Candida species from HIV/AIDS patients in Iran from 1999 to 2024, finding high resistance to clotrimazole and recommending certain drugs for treatment.

## Contribution

The study provides a comprehensive meta-analysis of antifungal resistance in Candida isolates from HIV/AIDS patients in Iran over 25 years.

## Key findings

- Candida spp. showed the highest resistance to clotrimazole (21%) and lowest to voriconazole, caspofungin, amphotericin B, and nystatin.
- Candida krusei showed high resistance to fluconazole (72%) and itraconazole (38%), while Candida glabrata showed significant resistance to clotrimazole (38%).
- Amphotericin B, caspofungin, and nystatin are recommended for treating Candida infections in HIV/AIDS patients in Iran.

## Abstract

Antifungal resistance in Candida species in individuals living with HIV/AIDS infections due to the scarcity of antifungal agents is important especially in Iran with an estimate of 46000 individuals living with HIV. This systematic review and meta-analysis aimed to determine the resistance rate of Candida spp. isolates from HIV/AIDS positive individuals in Iran 1999-2024.

PubMed, Scopus, Web of Science, MagIran, Scientific Information Database, and Google Scholar were searched. For each database, title-and-abstracts screening was independently performed by two review authors. The assessment of the risk of the bias of the included studies and the data extraction were performed independently by two review authors using JBI Critical Appraisal Checklist for Studies Reporting Prevalence data. Wherever suitable, meta-analysis was performed using a random-effects model with Freeman-Tukey double arcsine transformation.

From the retrieved 4925 references, 18 references related to 15 studies with 1318 Candida spp. isolates were included. The highest pooled resistance rate of Candida spp. was observed against clotrimazole (21%, 95% CI: 14-30, I2=67.29%) while the lowest pooled resistance rates of Candida spp. were observed against voriconazole, caspofungin, amphotericin B, and nystatin with the pooled estimates of zero percent. In species level, the highest pooled resistance rates were observed for Candida krusei against fluconazole (72%, 95% CI: 0-100%) and itraconazole (38%, 95% CI: 17-62%) and for Candida glabrata against clotrimazole (38%, 95% CI: 27-50%).

The use of amphotericin B, caspofungin, and nystatin for the treatment of Candida spp. in HIV-AIDS patients in Iran is recommended based on clinical indication.

All Authors: No reported disclosures