Current status and prospects in diagnosis of major opportunistic fungal infections among HIV-positive population in south provinces of China and neighboring countries that are suffering high prevalence of AIDS.

People living with human immunodeficiency virus (HIV) are highly susceptible to opportunistic fungal infections, such as Talaromyces marneffei, Candida, and Pneumocystis jirovecii, primarily due to their immunocompromised status. These infections often manifest as invasive candidiasis, pneumonia, and other severe diseases. Consequently, diagnostic failures for these specific infections remain a leading cause of HIV-related mortality. This review systematically evaluated the currently available diagnostic tools for these pathogenic fungi. Traditionally, etiologic detection, particularly fungal cultivation, has been considered the gold standard for diagnosis. Simultaneously, methods such as microscopic examination, molecular biology tests, and immunological diagnostic technologies are rapidly advancing and becoming increasingly applicable. However, persistent limitations in efficiency, accuracy, reliability, and cost-effectiveness continue to impede clinical diagnosis. This dilemma significantly hampers the advancement of clinical diagnosis for opportunistic fungal infections in HIV-positive populations both in China and globally. Given this diagnostic challenge, there is an urgent need for the further development of novel tools and strategies. These efforts should focus on promoting the identification of molecular targets, innovating targeted probes, exploring detection platforms, and designing diagnostic techniques. Ultimately, improvements in the clinical diagnosis of opportunistic fungal infections will directly contribute to a reduction in the HIV-related mortality rate.