Antifungal use in HIV infection

Systemic fungal infections continue to be a major cause of morbidity and mortality among HIV-infected patients. Mucosal candidiasis remains the most common fungal disease in this population, while cryptococcosis and aspergillosis are associated with significant mortality. Histoplasmosis and penicilliosis are relatively common in some areas. Blastomycosis, coccidioidomycosis and paracoccidioidomycosis have also been described in association with HIV. Over the last decade, a number of clinical trials have evaluated the use of antifungal therapies in this population and shaped our approach to prophylaxis and therapy. This report outlines the state of the art in the management of HIV-associated fungal infections and discusses the unique difficulties and drug-drug interactions associated with managing fungal infections in this population. Deoxycholate or liposomal formulations of amphotericin B and the triazoles fluconazole and itraconazole are the most commonly used antifungal agents. Healthcare providers should be familiar with the appropriate antifungal management and its limitations. Possible interactions with antiretrovirals should be considered when prescribing antifungal treatment. An exciting new decade in antifungal therapy is beginning, in which the second-generation triazoles and echinocandins will hopefully help us to overcome the limitations of the current antifungal arsenal.