[Secondary prevention of esophageal candidiasis with fluconazole in acquired immunodeficiency syndrome]

In order to evaluate the efficacy of 200 mg single weekly dose of fluconazole in the secondary prophylaxis of esophageal candidiasis in AIDS, 18 patients who had an endoscopic confirmation of cure after an esophageal candidiasis, were studied. Mean follow up period was 12.5 months (limit: 1.5-18) and 11 patients completed prophylaxis for 11.2 months (limit: 2-18). Fluconazole was interrupted in the 7 remaining patients due to different reasons after 10 months and they were followed for 3.2 more months (limit: 1-5). Ten patients relapsed with a total of 17 episodes (7 oropharyngeal and 10 esophageal). Only 4 of the 18 patients (22%) relapsed while on correct prophylactic treatment. On the other hand, 6 out of 7 patients (86%) relapsed in the absence of fluconazole (p less than 0.001). The relapse incidence rate in both groups was 0.09 and 1.46/100 patients/day respectively (p less than 0.001) and its appearance was much earlier (1.3 versus 9.5 months) in patients not receiving prophylaxis. Relapses did not correlate with CD4 cell level, HIV-Ag level, opportunistic infections, use of other drugs or mortality. Fluconazole was interrupted in 3 patients because of alternations in liver enzymes although its relationship with the drug was not confirmed. These results indicate that the administration of Fluconazole 200 mg/week in a single dose is very efficiency in secondary prophylaxis of esophageal candidiasis in AIDS patients.