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Prophylaxis with weekly versus daily fluconazole for fungal infections in patients with AIDS

D V Havlir1, M P Dubé, J A McCutchan

  • 1University of California, San Diego, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|December 30, 1998
PubMed

Insights

A weekly fluconazole dose effectively prevents deep fungal infections in patients with human immunodeficiency virus (HIV). However, daily fluconazole is more effective at preventing thrush, a common fungal complication.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Public Health

Background:

  • Deep fungal infections are serious complications in patients with acquired immunodeficiency syndrome (AIDS).
  • Fluconazole is commonly used for fungal infection prophylaxis in immunocompromised individuals.

Purpose of the Study:

  • To compare the efficacy of once-weekly versus daily fluconazole for preventing deep fungal infections in HIV-infected patients.
  • To determine if a less intensive fluconazole regimen is effective in preventing fungal complications.

Main Methods:

  • Multicenter, randomized, double-blind trial involving 636 HIV-infected patients.
  • Comparison of 400-mg once-weekly fluconazole versus 200-mg daily fluconazole.
  • 74 weeks of follow-up with intent-to-treat analysis.

Main Results:

  • Deep fungal infections occurred in 5.5% of daily fluconazole recipients and 7.7% of weekly recipients (risk difference, 2.2%).
  • Thrush occurred twice as frequently in weekly versus daily fluconazole recipients (hazard ratio, 0.59).
  • Fluconazole resistance was infrequent in a subset of evaluated patients.

Conclusions:

  • Once-weekly fluconazole is effective in reducing deep fungal infections in patients with AIDS.
  • The 200-mg daily dosage of fluconazole is more effective than the weekly dosage in preventing thrush.

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