Safety and efficacy of posaconazole in the long-term treatment of azole-refractory oropharyngeal and esophageal candidiasis in patients with HIV infection.
OBJECTIVE
To evaluate safety and efficacy of long-term posaconazole in HIV-infected patients with azole-refractory oropharyngeal candidiasis and/or esophageal candidiasis.


METHODS
In this noncomparative, open-label study, participants received oral posaconazole 400 mg twice daily (bid) for 3 months. Enrolled patients (N = 100) included 60 from a previous 1-month acute study of posaconazole and 40 posaconazole-naïve participants. Participants with a clinical response could be followed untreated for up to 1 month afterwards. Participants who relapsed during follow-up, showed improvement at the end of 3 months of treatment (EOT), or were cured but likely to benefit from further therapy could continue on posaconazole 400 mg bid for up to 12 months.


RESULTS
In the modified intent-to-treat population, clinical response (cure or improvement) occurred in 85.6% (77/90) at EOT. The results were similar in the previously treated participants and the posaconazole-naïve participants, 88.1% (52/59) and 80.6% (25/31), respectively. Posaconazole was well-tolerated, showing a similar safety profile during the 3-month study period and during suppressive therapy. The most frequently reported treatment-related adverse event was vomiting (4/100, 4%) during the early follow-up period (on or before day 105) and elevated hepatic enzymes (3/51, 6%) during the long-term follow-up (after day 105).


CONCLUSIONS
Oral posaconazole 400 mg bid demonstrated long-term safety, tolerability, and efficacy, offering a long-term, suppressive treatment option for HIV-infected participants with azole-refractory mucosal candidiasis.
Vazquez
J A
JA
Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan 48202, USA. JVAZQUE1@hfhs.org
Skiest
D J
DJ
Tissot-Dupont
H
H
Lennox
J L
JL
Boparai
N
N
Isaacs
R
R
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001393:Azoles / Q000494:pharmacology / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology; D002180:Candidiasis, Oral / Q000188:drug therapy; D025141:Drug Resistance, Fungal / Q000187:drug effects; D004798:Enzymes / Q000097:blood; D004935:Esophageal Diseases / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D010608:Pharyngeal Diseases / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D014839:Vomiting
D000935:Antifungal Agents; D001393:Azoles; D004798:Enzymes; D014230:Triazoles; C101425:posaconazole