Incidence and characteristics of candidemia in hospitalised patients with advanced HIV in the Médecins Sans Frontières (MSF) hospital in Kinshasa, Democratic Republic of Congo (DRC)

AIDS Research and Therapy https://doi.org/10.1186/s12981-026-00890-5 Article in Press Incidence and characteristics of candidemia in hospitalised patients with advanced HIV in the Médecins Sans Frontières (MSF) hospital in Kinshasa, Democratic Republic of Congo (DRC) Received: 6 March 2026 Accepted: 16 April 2026 Cite this article as: Walo C., Kisaka P., Mikobi Maleshila J. et al. Incidence and characteristics of candidemia in hospitalised patients with advanced HIV in the Médecins Sans Frontières (MSF) hospital in Kinshasa, Democratic Republic of Congo (DRC). AIDS Res Ther (2026). https://doi.org/10.1186/ s12981-026-00890-5 A Chadrack Walo, Patrick Kisaka, Jean-Claude Mikobi Maleshila, Ghislain Mwenemboka, Fidèle Kutomisa, Ridi Fuka, Nadine Ntabugi, Judith Mulanga, Augustin Nzembomba, Astan Dicko, Alain Tshimungu, Charles Kasenda, Gisèle Mucinya, Fabiola Gordillo Gomez, Rosie Burton, Pilar Garcia-Vello & Agnese Comelli E R P S S We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply. E L C IN If this paper is publishing under a Transparent Peer Review model then Peer Review reports will publish with the final article. I T R © The Author(s) 2026. 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To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. ACCEPTED ARTICLEMANUSCRIPT IN PRESS BRIEF COMMUNICATION: Incidence and characteristics of candidemia in hospitalised patients with advanced HIV in the Médecins Sans Frontières (MSF) hospital in Kinshasa, Democratic Republic of Congo (DRC) Chadrack Walo1, Patrick Kisaka1, Jean-Claude Mikobi Maleshila1, Ghislain Mwenemboka1, Fidèle Kutomisa1, Ridi Fuka1, Nadine Ntabugi1, Judith Mulanga1, Augustin Nzembomba1, Astan Dicko2, Alain Tshimungu1, Charles Kasenda1, Gisèle Mucinya1, Fabiola Gordillo Gomez2, Rosie Burton3, Pilar GarciaVello2,4, Agnese Comelli2 1 Médecins Sans Frontières, Democratic Republic of Congo, Kinshasa, 2 Médecins Sans Frontières, Middle East Medical Unit, Beirut, Lebanon, 3 Médecins Sans Frontières, MSF Academy, Belgium, Brussels 4 Médecins Sans Frontières, Operational Research and Epidemiology Support Unit (LuxOR). Luxembourg, Luxembourg S S E CORRESPONDING AUTHOR: Agnese Comelli E L C Rue de l'Arbre Bénit 46 1050 Ixelles Belgium I T AR IN PR ACCEPTED ARTICLEMANUSCRIPT IN PRESS ABSTRACT Candidemia is an underrecognized complication among patients with advanced HIV disease (AHD), particularly in low‑resource settings. We conducted a retrospective study at an MSF-supported hospital in Kinshasa (2022–2025) to describe the incidence, characteristics, and outcomes of candidemia. Among 3,974 AHD admissions, 46 candidemia cases (1.2%) were identified, more than 80% of which were healthcare‑associated. Mortality was high (76.1%) and many deaths occurred before microbiological confirmation. Classical risk factors, such as indwelling catheters and parenteral nutrition, were uncommon, suggesting alternative pathogenic mechanisms. Findings highlight the need for improved diagnostics and access to antifungal susceptibility testing. Keywords: candidemia, advanced HIV disease, LMIC S S E I T AR E L C IN PR ACCEPTED ARTICLEMANUSCRIPT IN PRESS INTRODUCTION Candida albicans is classified by the World Health Organization (WHO) as a critical fungal priority pathogen(1). Globally, invasive fungal infections are rising, and candidemia carries high mortality, estimated at 20–50% even with appropriate treatment(1). In low‑income countries (LIC), diagnosis and management are further hindered by limited diagnostics, restricted antifungal availability, and emerging resistance. Fungal diseases receive limited attention and funding, resulting in major gaps in epidemiological data and challenges in estimating the global burden of candidemia, especially in LIC. Evidence is particularly scarce for people living with HIV. Few studies have addressed invasive Candida spp. infections in patients with advanced HIV disease (AHD) in such settings(2,3). AHD is characterised by a CD4 count below 200 cells/mm3 or a WHO HIV clinical stage of 3 or 4. Although WHO clinical stage 3 or 4 includes oral candidiasis and oesophageal candidiasis, HIV infection is not traditionally considered a major risk factor for invasive Candida infections(4). However, AHD presents multiple predisposing factors for candidemia, including low CD4 count, malnutrition, cachexia, Candida colonisation, neutropenia or neutrophil dysfunction, exposure to broad-spectrum antibiotics, prolonged hospitalisation, central venous catheter (CVC) use, and increased intestinal translocation(5,6). Within the Médecins Sans Frontières (MSF) HIV/AIDS project at Centre Hospitalier de Kinshasa (CHK), extensive experience in the care of people with AHD, combined with microbiological capacity since 2022, provides a unique opportunity to address this evidence gap. S S E PR This study aims to describe the incidence, clinical and management characteristics, and outcomes of candidemia among hospitalised patients with AHD at an MSF-supported hospital in Kinshasa, Democratic Republic of Congo. MATERIALS AND METHODS E L C IN I T AR A retrospective observational study was conducted between September 2022 and April 2025 at the MSF-supported Centre Hospitalier de Kinshasa (CHK). Adult patients with advanced HIV disease (AHD; CD4 <200 cells/mm³ or WHO stage 3–4) and candidemia, defined as at least one blood culture positive for Candida spp., were included. Blood culture collection criteria utilised in this facility are presented in table S1 (see supplementary). When yeast was detected on Gram stain, clinicians were informed, and an India ink test was performed to differentiate Candida spp. from Cryptococcus spp. If negative, candidemia was confirmed. Species identification and antifungal susceptibility testing (AST) were not available. Cryptococcus antigen test is available. CHK provides comprehensive AHD care, including intensive care unit (ICU) admission, oxygen support, intravenous therapies via peripheral access and inc (...truncated)