Ae. Heald et al., OROPHARYNGEAL YEAST FLORA AND FLUCONAZOLE RESISTANCE IN HIV-INFECTED PATIENTS RECEIVING LONG-TERM CONTINUOUS VERSUS INTERMITTENT FLUCONAZOLE THERAPY, AIDS, 10(3), 1996, pp. 263-268
Objective: To examine the impact of continuous versus intermittent flu
conazole therapy on fungal colonization and fluconazole resistance in
the oropharynx of HIV-infected patients. Design: Case-control study. S
etting: Duke University Adult Infectious Diseases Clinic, a tertiary r
eferral center in North Carolina which provides care for 700 HIV-infec
ted persons. Patients: Nineteen HIV-infected patients on daily continu
ous fluconazole for a minimum of 6 months and eleven HIV-infected pati
ents on intermittent fluconazole for a minimum of 6 months were matche
d by sex and CD4 cell count to HIV-infected patients who had not recei
ved fluconazole in the preceding 6 months. Main outcome measures: Fung
al isolation and fluconazole susceptibility testing were performed on
oral saline rinses from each patient. Results: The patients taking con
tinuous fluconazole were more likely than matched controls to have had
sterile mouth rinses (14 out of 19 versus five out of 19; P < 0.001),
and the yeasts that were isolated were more likely than matched contr
ols to be non-Candida albicans species and to have minimum inhibitory
concentrations (MIC) to fluconazole greater than or equal to 16 mu g/m
l. None of these isolates were associated with symptoms. In contrast,
none of the patients in the intermittent fluconazole group had sterile
cultures. When this group was compared to controls, they were more li
kely to have had non-C. albicans species, and the C. albicans isolates
obtained had higher MIC to fluconazole.Conclusions: Long-term continu
ous therapy with fluconazole may prevent the appearance of Candida in
the oral cavity. This finding may reduce recurrence rates and might fa
vorably impact on the clinical appearance of mucosal candidiasis with
resistant C. albicans.