Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

20 patients (18 men, 2 women), 10 of whom were HIV +, were given Fluconazole (F) for either systemic candidiasis (13 cases), histoplasmosis (1), or cryptococcosis (6). The localization of the Candida infections (12 C. albicans, 1 C. tropicalis), were: septicemic (2), urinary (7), bronchial (2), esophageal (5), uveal (1), soft tissue (2), and 1 undetermined localization but a positive serology (1). On day (d) 1, Candidiasis patients were given an initial dose of 400 mg (for septicemia) or 200 mg (other localizations) of FIV or PO, then 200 or 100 mg per d. The length of treatment lasted from 28 to 70 d. Evolution was favorable in all the patients. 4 relapses occurred after the end of treatment: at 10 d, a septicemic candidiasis (C. tropicalis) in 1 patient who had prosthetic endocarditis; and at 1 month, digestive candidiasis in 3 HIV + patients. For the patient, infected by Histoplasma capsulatum, despite a clinical improvement, urine were still positive at day 75. The patients with cryptococcosis (5 meningitidis in the AIDS patients) and renal (1) (kidney transplant) were given on the average 400 mg a d, IV or PO (mean length 8 weeks). Only 5 patients were evaluable. For 2 of the meningitis patients with other localizations, standard treatment was instituted due to the persistence of positive cultures. For the 2 other patients, the cerebrospinal fluid (1) and the urine (1) were sterilized by the 3d week. But they relapsed 1 month after the treatment stopped. For the 18 patients evaluable, clinical and biological tolerance was good except for 1 patient with transaminases rise for which fluconazole was probably the cause.
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PMID:[Value of fluconazole in the treatment of systemic yeast infection]. 255 80

Seventy-one patients with oropharyngeal candidosis received treatment with fluconazole given as a single 50 mg capsule once daily. Of these patients 61 were HIV-antibody positive. Candidosis had been present in nearly all patients for a least one month prior to fluconazole treatment. The duration of daily therapy was 5-20 days and in many cases this was followed by a period of maintenance treatment using 50 mg fluconazole every 48 h. In all 42 symptomatic patients, clinical resolution of the infection occurred within 7 days. Significantly, this included the disappearance of dysphagia in four patients with proven candidal oesophagitis. A marked reduction, or eradication of oral yeasts occurred concomitantly in virtually all patients. Fluconazole was well tolerated by all patients and there were no significant changes in haematological or hepatic parameters that could be attributed to the drug. The results suggest that fluconazole is an appropriate treatment for oropharyngeal candidosis and comparative studies with other agents should now be conducted.
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PMID:Fluconazole in the management of oropharyngeal candidosis in a predominantly HIV antibody-positive group of patients. 283 59

Fluconazole pharmacokinetics, including absolute bioavailability, were determined for one group of controls (n = 10) and two groups of people with human immunodeficiency virus (HIV) infection (those with CD4+ T-cell counts of less than [n = 4] or greater than [n = 9] 200 cells per mm3). Twenty subjects received four doses of fluconazole; three doses were oral (50, 100, and 400 mg), and one dose was intravenous (either 50, 100, or 400 mg). The other three subjects received one or two doses. The groups were comparable in terms of the weight, body mass index, and estimated creatinine clearance of the subjects, but the people with HIV infection were older. Pharmacokinetic parameters indicated linearity in all subjects; the area under the plasma concentration-time curve and the maximum concentration increased in proportion to the dose. The fraction of an oral dose of fluconazole absorbed approximated unity in all three groups of subjects. The mean (+/- standard deviation) plasma clearance of fluconazole was lowest in the group of subjects with low CD4+ T-cell counts; the value for this group was 0.74 +/- 0.19 liter/h, compared with 0.97 +/- 0.19 liter/h in the group with HIV infection and CD4+ T-cell counts of greater than 200 cells/mm3 and 1.18 +/- 0.23 liter/h in the group of control subjects (P < 0.05). The volume of distribution was lower in those with HIV infection (P = 0.04, corrected for weight). The half-life was longest in people with HIV infection and low CD4+ T-cell counts (P = 0.01). This study has shown that some differences do exist between the pharmacokinetics of fluconazole in people with HIV infection and those in noninfected controls.
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PMID:Pharmacokinetics and bioavailability of fluconazole in two groups of males with human immunodeficiency virus (HIV) infection compared with those in a group of males without HIV infection. 748 28

Oral candidiasis is a frequent opportunistic infection in AIDS patients. High risk of dissemination and frequent relapses are common. The autors in Dakar at the Infectious Diseases Department Fann Hospital conduct an open non randomized trial with Fluconazole for the treatment of oral candidiasis in HIV seropositive patients. They find a clinical efficacy of 84.14% a biological efficacy of 63.3% and a good excellent tolerance (100%). But, the high price of this product limits its utilisation in developing countries.
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PMID:[Fluconazole in oro-pharyngeal candidiasis in retroviral infection (experience in Dakar)]. 788 56

Severe fungal infections have become increasingly common over the past 10 years, largely due to the greater number of immunocompromised patients, such as those infected with HIV and those undergoing immunosuppressive therapy for malignancies. Between 60% and 80% of people with AIDS, for example, develop at least one fungal infection. Other predisposing factors for these infections include mechanical defects such as indwelling catheters, surgery, and burns. Candidiasis, aspergillosis, cryptococcoses, coccidioidomycosis, and histoplasmosis are among the fungal infections most commonly encountered in the clinical setting. Diagnosis is often elusive and treatment difficult. Amphotericin B has been the standard therapy for most life-threatening fungal infections for almost three decades but has significant drawbacks, including severe adverse reactions. Other systemic antifungal agents have proved useful in certain situations. Fluconazole, a new broad-spectrum agent, has shown particular promise in the treatment of candidiasis and cryptococcal meningitis.
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PMID:Fungal infections associated with malignancies, treatments, and AIDS. 795 89

In an open, noncomparative, multicentre study the efficacy and safety of oral fluconazole was evaluated in the treatment of oropharyngeal candidiasis in children with HIV infection. Fifty-one children with a mean age of five years were enrolled. Oropharyngeal candidiasis was caused by Candida albicans in 28 cases (55%). Fluconazole was given in a mean dosage of 3.4 mg/kg/d (range 2 to 5.6 mg/kg/d) for a mean duration of 12 days (range 6 to 28 days). By the end of treatment, 90% of the children were clinically cured, 6% had improved and 4% failed to respond. Candida was eradicated in 82% of the patients. Clinical failure occurred only in children given 3 mg/kg/d or less. Two and four weeks after therapy, clinical cure was confirmed in 88% and 82% of the children respectively as well as eradication in 76% respectively. Six children experienced mild side effects (1 skin rash, 5 mild elevation of liver enzyme levels). The data show that fluconazole is safe and effective in treating oropharyngeal candidiasis in HIV-infected children.
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PMID:Treatment of oropharyngeal candidiasis in HIV-infected children with oral fluconazole. Multicentre Study Group [corrected]. 807 Apr 42

Far and away the most common fungal infection associated with HIV infection is candidiasis. This tends to produce mucosal topical infections and local treatment may be enough to control them. Generally we prefer courses of 1-2 weeks rather than chronic suppression, for fear of eliciting overgrowth of resistant isolates. Fluconazole resistant Candida species may be an increasing problem over the next decade. For cryptococcoses the problem is both simpler and more complicated. Fluconazole is highly effective for chronic suppression, but not very effective for initial therapy. Here a short course of amphotericin B, just 2 weeks in length, is followed by chronic azole suppression. Fluconazole appears excellent, but itraconazole may also be effective. For histoplasmosis itraconazole appears to be the most advantageous drug, with excellent clinical response within 2 weeks. A role for fluconazole is unclear. Coccidioidomycosis is uncommon, but difficult. I cannot offer any suggestions on "ideal" therapy here. Other diseases, such as aspergillosis, are extremely uncommon but still are AIDS associated mycoses. It is my personal fear that as we go along identifying the AIDS virus and its complications, aspergillosis and zygomycosis may establish themselves as the future "black hats" for which we will need to pull something out of the "box". What to pull is not very clear.
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PMID:Treatment of systemic mycoses in patients with AIDS. 811 65

A total of 334 HIV-infected patients with oral candidiasis were randomly assigned to receive 14 days of treatment with either 100 mg of oral fluconazole once daily or 10 mg clotrimazole five times daily. Both treatments were clinically effective: 98% of evaluable fluconazole-treated patients and 94% of evaluable clotrimazole-treated patients were cured or showed improvement (p = NS). Fluconazole was more effective than clotrimazole in eradicating Candida from the oral flora by the end of therapy (65% versus 48%) (p = 0.005). In addition, patients in the fluconazole-treated group were more likely to remain asymptomatic through the second week of follow-up (82.3% versus 50.0%) (p < 0.001). This difference was no longer evident by the post-therapy visit during week 4. Seven patients treated with clotrimazole and two patients treated with fluconazole discontinued therapy because of side effects. Two patients in the fluconazole group were withdrawn from therapy because of elevated serum glutamic-oxaloacetic transaminase levels, one considered possibly related to drug therapy. Fluconazole was as effective as clotrimazole in the treatment of oral candidiasis and temporarily provided a more prolonged disease-free state. Future studies are needed to define the optimal regimen for both the treatment and prevention of recurrent oral candidiasis in HIV-infected patients, addressing special attention to the issue of compliance, cost, and emergence of resistance.
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PMID:Therapy for oropharyngeal candidiasis in HIV-infected patients: a randomized, prospective multicenter study of oral fluconazole versus clotrimazole troches. The Multicenter Study Group. 825 68

Fluconazole is a triazole antifungal agent which is now an established part of therapy in patients with immune deficiencies. It is effective against oropharyngeal/oesophageal candidiasis (candidosis) when used orally once daily either as treatment or secondary prophylaxis in patients with AIDS or as treatment or primary prophylaxis in neutropenia associated with cancer therapy. Fluconazole also resolves symptoms in up to 60% of patients with cryptococcal meningitis and AIDS. However, in this infection its efficacy as treatment relative to that of amphotericin B is equivocal, and its major role is as the drug of choice for maintenance therapy following amphotericin B induction. In this regard, fluconazole has been proven superior to amphotericin B and to itraconazole 200 mg/day. Comparisons with other drugs used for the treatment of mucosal candidiasis in patients with AIDS show fluconazole to be superior to nystatin, similar to itraconazole and at least as effective as clotrimazole and ketoconazole; it was more so than the latter azole in 1 study. In patients undergoing chemotherapy or bone marrow transplantation, fluconazole as primary prophylaxis has produced greater clinical benefit than a clotrimazole regimen. The incidence of adverse events appears to be somewhat higher in patients with AIDS compared with HIV-negative cohorts, but the qualitative pattern of events is similar. The most frequent events are gastrointestinal complaints, headache and skin rash: rare exfoliative skin reactions and isolated instances of clinically overt hepatic dysfunction have occurred in patients with AIDS. Issues yet to be clarified include: the use of fluconazole in children with AIDS, in whom results have been promising; its efficacy against other fungal infections encountered in immunocompromised patients; whether the drug influences mortality, as has been suggested by one placebo-controlled trial in patients undergoing bone marrow transplant; and the appropriateness of its potential for use as primary prophylaxis against cryptococcal meningitis in patients with AIDS, where it shows efficacy but there is concern over increasing risk of development of secondary resistance. Notwithstanding these undefined aspects of its clinical profile, fluconazole is now confirmed as an important antifungal drug in the management of fungal infections in patients with immune deficiencies. In patients with AIDS it is the present drug of choice as maintenance therapy against cryptococcal meningitis and is a preferred agent for secondary prophylaxis against candidal infections; it is also a favoured agent for primary prophylaxis in patients at risk because of neutropenia associated with chemotherapy or bone marrow transplantation .
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PMID:Fluconazole. An update of its pharmacodynamic and pharmacokinetic properties and therapeutic use in major superficial and systemic mycoses in immunocompromised patients. 853 53

Azole-derived antifungal medications are particularly involved in drug-induced hepatic injury encountered in patients with AIDS. Fluconazole may induce multiple hepatic abnormalities usually characterized by asymptomatic and reversible mild hepatic necrosis. We here describe severe subacute liver damage occurring in a patient with AIDS who was receiving fluconazole maintenance therapy for a cryptococcosis. Hepatotoxicity was essentially characterized by mixed cytolytic and cholestatic liver tests abnormalities which improved after fluconazole discontinuation and worsened on fluconazole rechallenge. Optical microscopy demonstrated nonspecific abnormalities including granular aspect of the cytoplasm of the hepatocytes. In contrast, analysis of electron microscopy revealed unusual unreported features characterized by giant mitochondria with paracrystalline inclusions and enlarged smooth endoplasmic reticulum. All microscopic abnormalities were reversed after discontinuation of fluconazole. We suggest that persistent increased hepatic enzymes in HIV-infected patient taking fluconazole should prompt suspension of the treatment. Prospective studies are needed to determine whether careful monitoring of hepatic tests should be recommended in AIDS patients on prolonged fluconazole maintenance therapy.
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PMID:Subacute mitochondrial liver disease in a patient with AIDS: possible relationship to prolonged fluconazole administration. 856 Nov 26


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