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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This prospective study evaluated the in vitro susceptibility of Candida albicans isolates recovered from the oral cavity of AIDS/ARC patients before and during long-term therapy with fluconazole. Thirty adults (15 with ARC and 15 with AIDS) with a first episode of thrush candidiasis were given oral fluconazole (Triflucan 50 mg; one capsule daily) for at least three months. Fungal susceptibility testing was performed before treatment, after one month, and at last follow-up (range 3.5-12 months; mean 5.7 months). MICs were determined using the agar dilution method with casitone (Difco 259-01) as the test medium at pH 7.2-7.4. There were two initial clinical failures (one with high MICs before and under treatment and one with an intermediate MIC initially and a rise in MIC under fluconazole). Four patients developed a clinical relapse with no change in MICs (which were low or intermediate). In six patients, clinical symptoms resolved but carriage of C. albicans persisted (low MICs). In 18 patients, clinical resolution with eradication of C. albicans was achieved. These data suggest that (1) clinical failures may be associated with in vitro resistance; (2) relapses under fluconazole maintenance therapy may develop in patients with advanced HIV disease despite the lack of change in the susceptibility of strains.
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PMID:[Treatment and secondary prophylaxis with fluconazole for oropharyngeal candidiasis in HIV-positive patients. A mycological analysis of failures]. 149 36

In order to evaluate the efficacy of 200 mg single weekly dose of fluconazole in the secondary prophylaxis of esophageal candidiasis in AIDS, 18 patients who had an endoscopic confirmation of cure after an esophageal candidiasis, were studied. Mean follow up period was 12.5 months (limit: 1.5-18) and 11 patients completed prophylaxis for 11.2 months (limit: 2-18). Fluconazole was interrupted in the 7 remaining patients due to different reasons after 10 months and they were followed for 3.2 more months (limit: 1-5). Ten patients relapsed with a total of 17 episodes (7 oropharyngeal and 10 esophageal). Only 4 of the 18 patients (22%) relapsed while on correct prophylactic treatment. On the other hand, 6 out of 7 patients (86%) relapsed in the absence of fluconazole (p less than 0.001). The relapse incidence rate in both groups was 0.09 and 1.46/100 patients/day respectively (p less than 0.001) and its appearance was much earlier (1.3 versus 9.5 months) in patients not receiving prophylaxis. Relapses did not correlate with CD4 cell level, HIV-Ag level, opportunistic infections, use of other drugs or mortality. Fluconazole was interrupted in 3 patients because of alternations in liver enzymes although its relationship with the drug was not confirmed. These results indicate that the administration of Fluconazole 200 mg/week in a single dose is very efficiency in secondary prophylaxis of esophageal candidiasis in AIDS patients.
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PMID:[Secondary prevention of esophageal candidiasis with fluconazole in acquired immunodeficiency syndrome]. 156 51

In 1987, data from the Centers for Disease Control AIDS data base indicated a 50% prevalence of oropharyngeal Candida infection, a 10% rate of esophageal infection, and .5% rate of bronchopulmonary infection among AIDS patients. Candida-positive blood cultures were found in 13 of 903 AIDS patients, and disseminated Candida infection was ascertained in 11 of 101 post mortem examinations of AIDS victims. 5 of 12 patients with oral Candida infection progressed to AIDS within a 42-week investigation as opposed to only 1 of 17 patients without Candida. In the former group, CD4 counts and CD4/CD8 ratios were also significantly lower. Most infections were caused by Candida albicans. Genital Candida occurs in 5-20% of women in reproductive age. In a study of 66 HIV-infected women Candida vaginitis preceded oral Candida infections which preceded Candida esophagitis. 33 women had vaginal infection, 25 had oral Candida, and 9 had esophageal infection with reduced CD4 counts. Infections of the oropharynx and the vagina are reduced CD4 counts. Infections of the oropharynx and the vagina are treated with amphotericin B, nystatin, miconazole, and clotrimazole. Systemically effective compounds include ketoconazole, itraconazole, and fluconazole, although interactions with rifampicin, phenobarbital, and phenytoin used in HIV treatment occur. Fluconazole is contraindicated in C. glabrata and C. krusei infections as it selects for azole-resistant Candida strains. Iv amphotericin B and fluconazole are used in serious infections when oral treatment is ineffective.
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PMID:Candida infections in AIDS patients. 161 60

Candidiasis of the oropharynx and oesophagus is one of the most common problems encountered in patients with HIV disease. Fluconazole is a bis-triazole antifungal agent with a long serum half-life. Sixteen anti-HIV positive patients (15 haemophiliacs and one blood transfusion recipient) with a clinical diagnosis of oropharyngeal candidiasis were treated with 50 mg fluconazole daily for 14-28 days and then either 150 mg fluconazole or placebo weekly for 6 months in a prophylactic phase. Clinical cure occurred in all patients, and mycological cure occurred in 13/16 (81%) patients. In the prophylactic phase, there were 2/5 (40%) relapses in the placebo arm compared with 1/8 (12.5%) in the fluconazole arm, but this was not statistically significant by Fisher's one-sided exact test (P = 0.31). It is concluded that fluconazole is an effective treatment of oropharyngeal candidiasis and has potential for prophylactic use.
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PMID:Fluconazole for oropharyngeal candidiasis in anti-HIV positive haemophiliacs. 188 20

Fluconazole is a recently approved agent for the treatment of certain fungal infections. Based on available studies, the drug is clearly effective in oropharyngeal candidiasis in immunosuppressed hosts. Current evidence suggests it may be more efficacious than other azole drugs for oropharyngeal disease. It is probably also effective in other infections due to Candida species, but controlled studies are lacking. Fluconazole is also efficacious in the treatment of cryptococcal meningitis, but recent reports question its use as initial therapy in HIV-infected patients with this illness. The drug, however, is clearly more effective than amphotericin B in the suppression of cryptococcal meningitis in AIDS patients and is the treatment of choice in this situation.
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PMID:Fluconazole: a new triazole antifungal agent. 189 59

Fluconazole, a new triazole derivative, was evaluated in a pilot study of 34 episodes of candidiasis in 24 children. All the patients had predisposing conditions, such as human immunodeficiency virus infection, cancer, organ or bone marrow transplantation, neonatal age and malnutrition, and obstructive uropathy. The drug was administered at 6 mg/kg (body weight) once daily either orally or intravenously. Two patients with fungemia due to Candida parapsilosis required an increased dosage of 12 mg/kg. Clinical and microbiological success was achieved in 30 of 34 cases (88%). Drug-related transaminase increases were observed in two cases (6%). Fluconazole may represent an effective alternative to amphotericin B in the treatment of candidiasis in children. Comparative trials are necessary to assess optimal dosages and efficacy.
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PMID:Fluconazole in the treatment of candidiasis in immunocompromised children. 202 68

Thirty-nine adult patients with human immunodeficiency virus infection and oral candidiasis were randomly assigned to receive either one fluconazole capsule (100 mg) or five clotrimazole troches (10 mg each) daily for 14 days. Among 36 evaluable patients, clinical resolution rates were 100 and 65%, respectively (P = 0.018). Mycological eradication rates were 75 and 20%, respectively (P = 0.004). Fluconazole-treated patients were more likely to remain disease free during follow-up than those treated with clotrimazole (P = 0.014 at 2 weeks). Prolonged clinical responses correlated with mycological eradication at the end of therapy (P = 0.043).
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PMID:Comparison of oral fluconazole and clotrimazole troches as treatment for oral candidiasis in patients infected with human immunodeficiency virus. 207 20

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.
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PMID:Oral candidosis in HIV-infected patients. 209 30

106 HIV-positive patients with 129 episodes of oropharyngeal Candida infection were treated with fluconazole (50-300 mg/d). Treatment lasted from 4 to 23 days. The majority of patients were in more advanced stages of HIV infection (82% AIDS cases). Therapy with fluconazole led to complete healing or improvement of clinical symptoms in 93% of all treatment courses. However, according to cultural findings, an elimination or recession of pathogens was achieved in only 70% of cases. Cultural monitoring showed a slow reduction of pathogens, as opposed to a fairly rapid clinical improvement. Candida albicans was the most frequently isolated Candida species (n = 128); the most selected Candida species during treatment were C. glabrata, C. krusei, and C. inconspicua. It is remarkable that C. glabrata, a low-grade pathogen, caused enanthema in 2 patients and a typical oral thrush in 1 patient. Fluconazole was well-tolerated, and apart from mild gastro-intestinal symptoms in 1 patient, no severe side effects were observed.
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PMID:Fluconazole in the treatment of oropharyngeal candidosis in HIV-positive patients. 209 39

The efficacy of fluconazole in doses ranging from 50 to 200 mg/day in controlling oropharyngeal candidiasis was retrospectively evaluated in 16 consecutive HIV-1-infected patients. 13 patients received fluconazole due to failure of treatment with ketoconazole, and among these 11 (84%) initially showed complete or partial remission of oropharyngeal candidiasis. 3 (27%) of these subsequently developed failure of treatment within a median observation period of 38 days. No major toxicities were observed. Fluconazole appears promising in the therapy of ketoconazole-resistant candidiasis.
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PMID:Fluconazole for ketoconazole-resistant oropharyngeal candidiasis in HIV-1 infected patients. 237 51


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