title: Opportunistic fungal infections in patients with acquired immune deficiency syndrome.
abstract: The recently developed antifungal agents itraconazole and fluconazole have been evaluated for primary and maintenance therapy for mycoses in patients with acquired immune deficiency syndrome (AIDS) in comparative and non-comparative trials. In oropharyngeal candidosis, ketoconazole may have to be given at a dose of 400 mg/day for comparable efficacy with fluconazole, 50 mg/day, because many patients with AIDS lack the gastric acid secretion necessary for drug absorption. Relapse rates were high. Itraconazole, 200 mg/day for 4 weeks, was as effective as ketoconazole, 400 mg/day, in achieving clinical remission and was better tolerated, but relapse rates were also high. An oral formulation of itraconazole in cyclodextrin has given clinical and mycological remissions in 39/39 patients after 7 days of treatment. In primary treatment of cryptococcosis, fluconazole is well tolerated, but is effective in only 50% of patients. Pilot studies of itraconazole, 200-400 mg/day, gave responses in 11/12 patients, of whom 8 had meningitis. Itraconazole combined with flucytosine gave a response in 12/13 patients, of whom 9 had meningitis. This combination shortened the time to cure. Both itraconazole and fluconazole are effective as maintenance therapy given after successful primary therapy of cryptococcosis. Itraconazole, 200 mg/day, was successful in preventing relapse in 34/39 patients over a mean 12-month period. The serum antigen titre fell progressively in 14, and fell to zero in 18 patients. Limited non-comparative trials suggest that triazoles are effective in coccidioidomycosis, and in particular that itraconazole is active against histoplasmosis in patients with AIDS; 8/9 patients with histoplasmosis responded to itraconazole, 400 mg/day, with a mean follow-up of 1 year.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Istituto di Igiene, Università di Milano, Ospedale Maggiore, Italia.
authors.forename: M A
authors.initials: MA
authors.lastname: Viviani
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy; D003453:Cryptococcosis / Q000188:drug therapy; D004311:Double-Blind Method; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D017964:Itraconazole; D007654:Ketoconazole / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009181:Mycoses / Q000188:drug therapy*; D009894:Opportunistic Infections / Q000188:drug therapy*; D009960:Oropharynx / Q000382:microbiology; D010865:Pilot Projects
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D015725:Fluconazole; D007654:Ketoconazole