RESISTANT CANDIDIASIS (REPRINTED FROM AIDS RES AND HUMAN RETROVIRUSES, VOL 10, PG 925-929, 1994)

Mucosal (oropharyngeal, esophageal, and, in women, vaginal) candidiasi s is a common infectious complication in HIV-infected patients. There is a wide range of drugs to treat or suppress Candida infections. Howe ver, with the increasingly common use of fluconazole as treatment or p rophylaxis in patients with relatively advanced HIV disease, mucosal c andidiasis that is clinically resistant to fluconazole is increasingly recognized. Susceptibility testing for fluconazole has not been well standardized, and laboratory and clinical correlations often have been difficult to demonstrate. However, the frequency with which Candida s trains resistant to fluconazole can be isolated appears to be increasi ng, particularly in patients with advanced HIV disease. Anecdotal resu lts suggest that patients who fail fluconazole therapy usually do not respond to higher doses of fluconazole, but may occasionally respond t o itraconazole or ketoconazole. In vitro susceptibility to these agent s does not necessarily ensure clinical efficacy. Amphotericin B is usu ally effective initially but requires parenteral administration. Howev er, with any therapy, relapses tend to occur and progressively recalci trant disease often occurs, with increasing morbidity for patients. Th ere is a clear need for studies addressing the incidence of resistance , the risk factors for its development, and more effective therapy.