CANDIDAL DISEASE IN AIDS


See also "Antifungals"

I. Candidal esophagitis

  1. Presentation: odynophagia, dysphagia, retrosternal pain
  2. Dx:
  1. Endoscopy: white plaques/exudate
  2. Endo brushings/bx: pseudohyphae
  1. Tx:
  1. Fluconazole 100-200mg Qd vs.
  2. Ketoconazole 200-400mg Qd:
  3. Flu gives more freq. cure (91% vs 52%) % relief of sx (85% vs 65%); both have minimal & comparable side f/x (AIM 117:655, 10/92)

 

II. Mucosal candidiasis

  1. 320 women with HIV and CD4 < 300 randomized to oral fluconazole 200mg Qwk vs. placebo; median f/u 29mos (Ann. Int. Med 126:689, 1997-JW)
  1. Risk of candidiasis sig. lower with fluconazole (44% vs. 58%)
  2. Sig. greater risk reduction in those who had had mucosal candidiasis previously (70% of pts)
  3. Risk of some side effect 20% with fluconazole, 14% with placebo
  4. No increase in clinical or in vitro candidal resistance
  1. 44 pts with HIV and CD4 < 350 and oropharyngeal candidiasis, not on any azole antifungals at start of study. All tx'd with fluconazole 200mg on day 1 then 100mg/d x 7d or until resolution of candidiasis. Then, randomized to continuous tx (fluconazole 200mg QD) vs. intermittent tx (tx only if & when recurrence occurred). Over mean f/u 11mos, symptomatic relapses occurred in 25% of pts on continuous tx vs. 82% on intermittent tx; 2/3 of relapses in the continuous tx group were ass'd with short breaks in use of fluconazole. Development of candidiasis resistant to fluconazole occurred in 13% of continuous group vs. 18% of intermittent group (Am. J. Med. 105:7, 1998--AFP)
  2. 194 HIV + pts > 19yo with CD4 < 400 and culture-proven oropharyngeal candidiasis were randomized to fluconazole 100mg PO x 14d vs. itraconazole oral solution 100mg QD x 14d or 100mg BID x 7d; cure rates and adverse event rates were similar in all 3 groups (Clin. Inf. Dis. 26:1368, 1998--AFP)