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Opportunistic candidal infections in patients infected with human immunodeficiency virus: prevention issues and

S E Reef1, K H Mayer

  • 1Emerging Bacterial and Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|August 1, 1995
PubMed

Insights

Mucosal candidiasis is common in people with HIV. While fluconazole prophylaxis can reduce risk, it

Area of Science:

  • Infectious Diseases
  • Immunology
  • HIV/AIDS Research

Background:

  • Mucosal candidiasis is a significant opportunistic infection in individuals with human immunodeficiency virus (HIV).
  • Esophageal candidiasis is an AIDS-defining illness, historically representing a substantial proportion of AIDS diagnoses in the US.
  • Diagnosis relies on clinical signs, symptoms, and laboratory tests (cultures, stains) for oropharyngeal/vaginal, and histopathology for esophageal/pulmonary forms.

Purpose of the Study:

  • To evaluate the role of fluconazole prophylaxis in preventing mucosal candidiasis in advanced HIV disease.
  • To assess current recommendations regarding primary and chronic prophylaxis for mucosal candidiasis in HIV patients.
  • To determine when long-term suppressive therapy for recurrent candidiasis is indicated.

Main Methods:

  • Review of a prospective controlled trial on fluconazole prophylaxis.
  • Analysis of diagnostic criteria for various forms of mucosal candidiasis.
  • Evaluation of expert opinions and clinical guidelines on prophylaxis strategies.

Main Results:

  • Fluconazole prophylaxis can reduce the incidence of mucosal candidiasis in advanced HIV.
  • Routine primary prophylaxis is generally not recommended due to treatment effectiveness, low mortality, resistance risk, and cost.
  • Chronic prophylaxis for recurrent oropharyngeal/vulvovaginal candidiasis is also typically not advised for similar reasons.

Conclusions:

  • While effective, routine primary and chronic prophylaxis for mucosal candidiasis in HIV is not recommended.
  • Treatment of acute disease is effective, and concerns about drug resistance and cost outweigh benefits for general prophylaxis.
  • Long-term suppressive therapy with fluconazole should be considered for frequent or severe recurrences after documented esophageal candidiasis.

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