CLINICAL CHARACTERISTICS AND MANAGEMENT RESPONSES IN 85 HIV-INFECTED PATIENTS WITH ORAL CANDIDIASIS

Eighty-five consecutively seen HIV-positive persons with oral candidia sis were evaluated for clinical characteristics, staging of HIV diseas e, quantitation of candidal colony formation, and response to systemic antifungal treatment with Nizoral (ketoconazole). Fifty-five had CD4 counts less than 200. There was an inconsistent association between cl inical signs, patient symptoms, CD4 counts, and candidal colony-formin g units. However, there was a trend toward higher colony-forming unit counts (>500) in patients with lower CD4 cells (<200). Sixty-five pati ents had a complete clinical response to the ketoconazole treatment (2 00 mg daily for 7 days), even though 81% of posttreatment cultures rem ained positive. Nonsmokers were more likely to respond to antifungal t reatment when compared with smokers, and there was a slight tendency f or complete responses when colony-forming unit counts were law. The mo st common lesion presentation was a combination of the white (pseudome mbranous) and red (erythematous) forms. Forty-nine percent had complai nts of pain. The variable responses indicated the importance of flexib le dose-time and drug considerations in antifungal management. Candida albicans was the predominant species.