The growing problem of mycoses in patients infected with the human immunodeficiency virus

With the rapid increase in cases of AIDS over the past 10 years, certain mycoses have dramatically risen in frequency, particularly those contained by T cell-mediated mechanisms of host defense. In this clinical setting mucocutaneous candidiasis as well as systemic cryptococcosis, histoplasmosis, and coccidioidomycosis pose special diagnostic and/or therapeutic challenges. Compared with fungal infections in general, AIDS-associated mycoses are more likely to have nonspecific clinical manifestations; moreover, treatments effective in other settings seldom are curative. These problems have led to new vigilance regarding mycoses in the differential diagnosis of complications of infection due to the human immunodeficiency virus (HIV) and have necessitated a redefinition of goals: the aim is now to suppress rather than cure infection in most cases. This change has stimulated trials of new antifungal agents and regimens particularly designed to facilitate long-term outpatient management of mycoses without interfering with treatment of either HIV infection itself or other concomitant complications.