title: Refractory mucosal candidiasis in advanced human immunodeficiency virus infection.
abstract: We conducted a multicenter, prospective study of the risk factors, natural history, and outcome of fluconazole-refractory mucosal candidiasis (FRMC) in 832 persons with advanced human immunodeficiency virus (HIV) infection (median CD4 cell count, 14/mm3) during 1994-1996. FRMC was defined as mucosal candidiasis that failed to resolve despite 14 days of therapy with daily doses (> or =200 mg) of fluconazole. Thirty-six persons (4.3%) had FRMC (35, oral; 1, esophageal), for an incidence of 4.2 per 100 person-years (859.7 total years of follow-up). In a multivariate model, the use of trimethoprim-sulfamethoxazole within 6 months of enrollment (relative risk [RR], 2.39; P=.04) and the use of fluconazole daily or every other day (RR, 5.64; P=.004) were significantly associated with the development of FRMC. The median survival after the development of FRMC was 32.6 weeks. In conclusion, the annual incidence of FRMC was <5%. Refractory candidiasis was a poor prognostic indicator. Daily or every-other-day use of fluconazole was associated with the development of refractory infection.
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA. carl.fichtenbaum@uc.edu
authors.forename: C J
authors.initials: CJ
authors.lastname: Fichtenbaum
authors.forename: S
authors.initials: S
authors.lastname: Koletar
authors.forename: C
authors.initials: C
authors.lastname: Yiannoutsos
authors.forename: F
authors.initials: F
authors.lastname: Holland
authors.forename: J
authors.initials: J
authors.lastname: Pottage
authors.forename: S E
authors.initials: SE
authors.lastname: Cohn
authors.forename: A
authors.initials: A
authors.lastname: Walawander
authors.forename: P
authors.initials: P
authors.lastname: Frame
authors.forename: J
authors.initials: J
authors.lastname: Feinberg
authors.forename: M
authors.initials: M
authors.lastname: Saag
authors.forename: C
authors.initials: C
authors.lastname: Van der Horst
authors.forename: W G
authors.initials: WG
authors.lastname: Powderly
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000145:classification / Q000302:isolation & purification; D002180:Candidiasis, Oral / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D004941:Esophagitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole