Ellagic acid: An alternative for antifungal drugs resistance in HIV/AIDS patients with oropharyngeal candidiasis

Oropharyngeal candidiasis (OPC) is considered the most common fungal infection in human immuÂnodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients. Antifungal drug, azole group, is the preferred treatment. However, the long-term use of antifungal drug as prophyÂlaxis and therapy for OPC may lead to a compromised side effects and drug resistance. Nowadays, the prevalence of antifungal Candida albicans resistance is approximately 56.7%. Ellagic acid (EA) presents broad spectrum of antifungal activities. Based on previous studies, EA can act as natural anÂtifungal agent. It also helps enhancing oral mucosal innate immunity. This review explores the antifungal activity of EA as an alternative for antifungal drugs resistance in HIV/AIDS patients with OPC. A web-based search was conducted via PubMed, NCBI, Scopus, ScienceDirect, and ResearchÂGate databases, with "antifungal resistance", "ellagic acid", "HIV/AIDS", and "OPC" as the keywords. EA is a dimeric derivative of gallic acid that is found in several plants. EA can induce the expression of hBD2 and SLPI in the oral mucosa. Those proteins play a pivotal role in immunomodulation and anti-inflammation of oral microenvironment innate immunity, which inhibit several opportunistic pathogens and microbes, including Candida. Furthermore, EA also inhibits ergosterol biosynthesis (EB), which is the primary component of fungi cell membrane. EA breakdown fungal membrane perÂmeability and enzyme activity, leading to cessation of fungal growth. EA presents antifungal activity in HIV/AIDS patients with OPC; thus, it can be used as an alternative in antifungal drug resistance.