Oral candidosis in HIV-infected patients

Over 80% of all HIV-infected patients develop oral candidosis at some stage during their disease. This provides a marker for the development of fullblown AIDS--in one study more than 50% proceeded to the full syndrome within three months of the development of buccal lesions, although some of these may have had asymptomatic oesophageal candidosis at the time of initial presentation. Oral candidosis appears to be particularly common in young children and Africans who are HIV-infected. Both pseudomembranous and atrophic forms occur, but the atrophic manifestation, which is often asymptomatic, often occurs earlier and is frequently missed. Median rhomboid glossitis and angular cheilitis are common. Topical treatment appears to be sufficient for atrophic candidosis and many cases of pseudomembranous infections also respond, although many clinicians would prefer to use a systemic antifungal agent in this situation because of the risk of oesophageal infection. Fluconazole, ketoconazole and itraconazole are all effective agents. In a prospective double-blind control study comparing itraconazole and ketoconazole, clinical response, mycological clearing and relapse rate were similar with both drugs. More than 95% of patients were free of symptoms within three weeks.