Ketoconazole-resistant Candida esophagitis in patients with acquired immunodeficiency syndrome

Although ketoconazole has been shown to be effective in treating esophageal candidiasis in other immunodeficiency states, similar studies have not been reported in patients with acquired immunodeficiency syndrome. Six patients with acquired immunodeficiency syndrome and oral and esophageal candidiasis who had been treated with ketoconazole for more than 2 mo were evaluated with barium esophagram and endoscopy with biopsy and brush cytology. All of the patients had persistent Candida esophagitis. In 2 patients, fungal cultures and sensitivity testing indicated Candida albicans resistant to ketoconazole in vitro. In patients with acquired immunodeficiency syndrome, esophageal candidiasis may not resolve with up to 6 mo of ketoconazole therapy and may require more vigorous antifungal therapy than in patients with other immunodeficiency states.