Decline in esophageal candidiasis and use of antimycotics in European patients with HIV.
BACKGROUND
Esophageal candidiasis (EC) remains one of the most common AIDS defining illnesses in patients with human immunodeficiency virus (HIV) in the era of highly active antiretroviral therapy (HAART), but little is known about factors associated with EC after starting HAART.


OBJECTIVE
To describe changes in the use of antimycotic medication, the incidence of EC and factors associated with EC before and after starting HAART.


METHODS
Patients from EuroSIDA, a pan-European longitudinal, prospective observational study. Generalized linear models and poisson regression models were used to investigate the relationships.


RESULTS
A total of 9,873 patients did not have EC at recruitment, subsequently 537 (15.8%) developed EC. The proportion of patients taking any antimycotic dropped from 18% at January 1995 to 2% at January 2004 (p < 0.0001); the duration of treatment declined from 10 to 3 months over the same period (p < 0.0001). There was a 32% annual decline in the incidence of EC (95% CI 30-35%, p < 0.0001). There was a significant annual decline in the incidence of EC pre-HAART in time-updated, adjusted models, (incidence rate ratio (IRR) 0.80, 95% CI 0.76-0.85, p < 0.0001) but not post-HAART (IRR 0.97; 95% CI 0.90-1.06, p= 0.54). Older patients and those with low CD4 counts had the greatest incidence of EC in the post-HAART era.


CONCLUSIONS
There has been a marked decline in the incidence of EC between 1994 and 2004. This was accompanied by a decline in markers associated with fungal disease, including use of antimycotics and a decline in duration of treatment.
Royal Free Centre for HIV Medicine and Dept Primary Care and Population Sciences, Royal Free and University College Medical School, London, United Kingdom.
Amanda
A
Mocroft
Cristina
C
Oancea
Jan
J
van Lunzen
Philippe
P
Vanhems
Denes
D
Banhegyi
Antonio
A
Chiesi
Elena
E
Vinogradova
Shlomo
S
Maayan
Andrew N
AN
Phillips
Jens
J
Lundgren
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000453:epidemiology*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology*; D004334:Drug Administration Schedule; D004935:Esophageal Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D016012:Poisson Distribution; D011446:Prospective Studies
D000935:Antifungal Agents