What to Know About Candidiasis When You Have HIV

Medically Reviewed by Jonathan E. Kaplan, MD on April 11, 2022
6 min read

If you have HIV, treatment called antiretroviral therapy (ART) can help you live a long, healthy life. But it’s a good idea to be aware of some of the health risks you might face, including fungal infections like candidiasis.

This infection usually affects the mouth, throat, esophagus, or vagina. When it shows up in your mouth or throat, doctors call it thrush.

Candidiasis can bring on painful symptoms that could make it hard for you to do things like eat food or keep up with any medicines that you take by mouth. A serious, possibly life-threatening form of the infection called invasive candidiasis can affect your blood and vital organs like the heart and brain. The infection can extend into the esophagus, which could lead to heartburn and difficulty swallowing. It can also extend into the trachea (airway) and lungs. Candidiasis of the mouth and throat (and lungs) are usually signs of advanced HIV and usually don’t happen if you are taking your ART.

Vaginal candidiasis produces a thick, white discharge that can be itchy and painful. It can occur at any stage of HIV infection, and often in persons who are not infected with HIV.

That makes it important to get treatment as soon as you have symptoms of candidiasis. Your doctor has ways to get rid of the infection and help you feel your best again.

A type of yeast called candida brings on this infection. Yeast is a type of fungus.

Candida usually lives on your skin and inside the body. Normally, the body’s defenses (immune system) keep it from multiplying and growing out of control. But when you’re living with HIV, the virus weakens your immune system. That makes it easier for candida to overgrow and cause the infection candidiasis.

Candidiasis of the esophagus (the tube that connects your throat to your stomach) is not as common as thrush but is more serious. And people who get the infection in their esophagus usually get it in the mouth and throat, too.

Vaginal candidiasis (also called a vaginal yeast infection) is common whether you have HIV or not. But HIV is one of several things that can make you more likely to get it.

Some oral symptoms are:

  • White patches on your tongue, inner cheeks, the roof of your mouth, or throat
  • Smooth, red areas on the back of your tongue
  • Pain or soreness in your mouth
  • Cotton-like, dry feeling in your mouth
  • Changes in taste
  • Feeling more sensitive to spicy foods
  • Less appetite than usual
  • Pain or trouble eating or swallowing
  • Cracks and redness at the corners of your mouth

Some vaginal symptoms are:

  • Itching, irritation, burning, or soreness
  • Pain during sex
  • Pain or discomfort while peeing
  • Thick, white discharge

It's possible to have no symptoms.

Most cases of vaginal candidiasis are mild, you can get a severe infection that includes redness, swelling, and cracks in the wall of your vagina.

If you get the serious type of “invasive” candidiasis that affects your blood or organs, it’s common to have fever and chills, too. You could get other symptoms if the infection spreads to other parts of your body, like your heart, brain, eyes, bones, or joints.

Talk to your doctor right away if you think you’re having any symptoms of candidiasis. The sooner you speak up, the faster you can get the right diagnosis and treatment.

If you have symptoms in your mouth and throat, your doctor may be able to diagnose candidiasis by taking a look inside. They may take a small sample from your mouth or throat and send it to a lab for testing.

If you have symptoms in your esophagus, your doctor may order a procedure called an endoscopy to diagnose it. An endoscopy involves placing a thin, flexible tube with a light and a tiny video camera on it down your throat to get a look at your esophagus. Or your doctor might give you antifungal medicine without doing an endoscopy to see if your symptoms improve.

If you’re having vaginal symptoms, your doctor usually takes a sample of any discharge. They may examine it under a microscope or send it to a lab for testing. If the test shows you have candida, that doesn’t necessarily mean it’s causing your symptoms. That’s because it’s possible to have this type of yeast in your vagina without it bringing on any symptoms.

Antifungal medicine is the usual treatment for candidiasis in the mouth, throat, or esophagus.

If you have a mild to moderate infection in your mouth or throat, your doctor may have you apply medicine (like clotrimazole, miconazole, or nystatin) to the inside of your mouth for up to 2 weeks. If your infection is severe, the doctor might have you take an antifungal drug called fluconazole by mouth or through a vein. They may have you take a different antifungal if fluconazole doesn’t help enough.

If you have candidiasis in your esophagus, your doctor will probably treat it with fluconazole or another type of prescription antifungal drug.

If you have vaginal candidiasis, it’s also usually treated with antifungal medicine. You either apply inside your vagina or take it once in pill form by mouth. Your doctor may have you take more doses of the fluconazole pill or apply different medicines in your vagina if your infection is severe, doesn’t get better, or keeps coming back. These other medicines include boric acid, flucytosine, or nystatin.

The most important thing you can do to prevent thrush and esophageal candidiasis is to take your ART as prescribed. You may be able to lower your chances of getting an infection in the mouth or throat by taking good care of your dental hygiene and keeping up with all your dentist appointments. If you take inhaled steroid medications, rinse your mouth or brush your teeth after you use them.

You might lower your chances for getting a vaginal yeast infection if you wear cotton underwear. Taking antibiotics can lead to vaginal candidiasis, so use these meds only when your doctor prescribes them. Follow the directions on how to take them exactly.

If you get frequent or severe candidiasis infections, your doctor might talk to you about taking fluconazole a few times a week to lower your odds of getting infected again. Take the medicine exactly as prescribed, and don’t stop taking it unless the doctor tells you to.

HIV weakens your immune system and raises your chances of getting candidiasis and certain other fungal infections. Follow these tips to help protect yourself:

Understand your CD4 count. This test shows if you’re low on infection-fighting white blood cells called CD4 cells. If your doctor says your count is low, you’re more vulnerable to infections. Work closely with the doctor to protect yourself.

Be aware of your surroundings. The CDC recommends taking these steps even though they’re not proven to prevent fungal infections:

  • Try to avoid places with lots of dust, like construction or excavation sites.
  • Stay indoors if there’s a dust storm in your area.
  • Avoid places with bird and bat droppings, like chicken coops and caves.
  • Wear gloves if you need to handle things like soil, moss, or manure.
  • Wear shoes, long pants, and a long-sleeved shirt if you garden, do yard work, or spend time in the woods.