Prognostic factors for the clinical effectiveness of fluconazole in the treatment of oral candidiasis in HIV-1-infected individuals.
OBJECTIVE
To identify prognostic factors for the clinical effectiveness of fluconazole in HIV-1-infected patients with oropharyngeal candidiasis.


METHODS
The study was designed as a prospective, open label, non-comparative, dose escalating, single centre trial.


METHODS
Thirty-four HIV-1-infected patients with oropharyngeal Candida infection were treated with 50 or 100mg fluconazoleday(-1), depending on the clinical manifestation (erythematous or pseudomembranous). The dose was doubled weekly until clinical cure. The predictive value of potential prognostic factors for the duration of treatment and cumulative fluconazole dose until cure was studied: exposure to fluconazole, previous use of fluconazole, the use of antiretroviral drugs, the CD4(+) cell count, erythematous or pseudomembranous appearance, the minimum inhibitory concentration (MIC) for fluconazole of the isolated Candida strain, and xerostomia.


RESULTS
Twenty-eight patients (with 30 episodes of oropharyngeal candidiasis) were evaluated. Twenty-five episodes were cured within 1-week of treatment, the remaining five episodes were cured within 2 weeks. No predictive value for any of the studied factors on the duration of fluconazole treatment or the cumulative fluconazole dose until cure was demonstrated.


CONCLUSIONS
Because of the high susceptibility to fluconazole and the positive clinical outcome, the variation in outcome measurements was too modest to establish a significant relationship between any of the investigated potentially prognostic factors and the cumulative fluconazole dose and the duration of treatment to reach cure. On the other hand it can be concluded, that fluconazole is very effective in patients with advanced HIV infection and low CD4(+) cell counts, even if they are not using antiretroviral agents.
Koks
C H W
CH
Department of Pharmacy and Pharmacology, Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, The Netherlands. apkko@slz.nl
Crommentuyn
K M L
KM
Mathôt
R A A
RA
Mulder
J W
JW
Meenhorst
P L
PL
Beijnen
J H
JH
D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D002180:Candidiasis, Oral / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D015725:Fluconazole / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018709:Statistics, Nonparametric
D015725:Fluconazole