Fluconazole compared with endoscopy for human immunodeficiency virus-infected patients with esophageal symptoms.
OBJECTIVE
The best initial treatment of human immunodeficiency virus (HIV)-infected patients with esophageal symptoms is unknown. The outcome, including safety and cost-effectiveness, of fluconazole compared with endoscopy as a treatment strategy for HIV-infected patients with new-onset esophageal symptoms was evaluated.


METHODS
During a 53-month period, 134 HIV-infected patients with esophageal symptoms were randomized prospectively to groups receiving either standard doses of fluconazole or endoscopy.


RESULTS
Among the 68 patients in the fluconazole group, a complete symptomatic response was observed in 56 patients (82%), usually within 1 week. The most common endoscopic findings in the 66 patients in the endoscopy group included Candida esophagitis alone in 42 patients (64%) and ulcerative esophagitis in 10 patients (15%). Patients responding to empirical antifungal therapy or who had Candida esophagitis alone at endoscopy were less like to have severe symptoms (P = 0.027) or odynophagia as the only symptom (P < 0.001) but more frequently had odynophagia and dysphagia (P = 0.007) and thrush (P = 0.002). Empirical fluconazole was cost-effective, saving $738.16 per patient.


CONCLUSIONS
Empirical oral antifungal therapy with fluconazole is highly efficacious, safe, and cost-effective for HIV-infected patients with new-onset esophageal symptoms.
Wilcox
C M
CM
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Alexander
L N
LN
Clark
W S
WS
Thompson
S E
SE
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy; D003362:Cost-Benefit Analysis; D004935:Esophageal Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D004941:Esophagitis / Q000188:drug therapy / Q000382:microbiology; D004945:Esophagoscopy / Q000191:economics; D005260:Female; D015725:Fluconazole / Q000191:economics / Q000627:therapeutic use*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
D000935:Antifungal Agents; D015725:Fluconazole