Refractory mucosal candidiasis in advanced human immunodeficiency virus infection.
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.
Fichtenbaum
C J
CJ
Washington University School of Medicine, St. Louis, MO, USA. carl.fichtenbaum@uc.edu
Koletar
S
S
Yiannoutsos
C
C
Holland
F
F
Pottage
J
J
Cohn
S E
SE
Walawander
A
A
Frame
P
P
Feinberg
J
J
Saag
M
M
Van der Horst
C
C
Powderly
W G
WG
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
D000935:Antifungal Agents; D015725:Fluconazole