Treatment of oropharyngeal candidiasis in HIV-positive patients

Most HIV-positive patients develop some form of oral candidiasis, most commonly pseudomembranous candidiasis, erythematous candidiasis, or angular cheilitis, at some point in their disease. All these manifestations are important risk markers for disease progression. Oral candidiasis is generally caused by Candida albicans. Although oral candidiasis can occur at any stage of HIV infection, it is most common in patients with low CD4 counts. Numerous oral and systemic therapies are used to treat oral candidiasis, the most popular of which are nystatin (topical), clotrimazole (topical), ketoconazole (systemic), fluconazole (systemic), and itraconazole (systemic). The topical agents are available in assorted dosage forms with varying degrees of efficacy and patient acceptability. The limited data currently available suggest an advantage for the systemic agents, although problems with resistance may limit the usefulness of fluconazole. The efficacy, safety, and cost effectiveness of a given agent must be considered when prescribing a specific agent for the treatment of oral candidiasis.