THERAPY OF CANDIDOSIS AND CRYPTOCOCCOSIS IN AIDS PATIENTS

Fungal infections figures large in HIV-infected patients. Candida infe ctions of the mucous membranes belong to the main manifestations of im munodeficiency in HIV infection. For therapy and prophylaxis of oropha ryngeal candidosis mainly systemically acting azoles as ketoconazole, fluconazole and itraconazole are applied; antimycotics to be administe red topically regularly fail to act in patients with progressing disea se. Ketoconazole tablets were used with good success in previous years of the AIDS epidemics. Application of ketoconazole in liquid formulat ion led to a significant increase in efficacy. Subsequently fluconazol e proved to be a triazole with evidently better pharmacological proper ties leading to good clinical efficacy. Presently it represents the dr ug of first choice in acute and maintenance therapy of recurrent oroph aryngeal and oesopharyngeal candidosis. In the case of therapy failure with fluconazole the administration of itraconazole in liquid cyclode xtrine formulation can replace or at least delay the administration of amphotericin B plus flucytosine, a therapy rich in toxic side effects . The standard therapy of disseminated cryptococcosis - particularly o f cerebral manifestation - is still the administration of amphotericin B combined with flucytosine. Alternative drugs are represented by flu conazole and itraconazole. However, an azole monotherapy seems to be l egitimate only in primary cryptococcosis of the lungs or in early stag es of secondary extrapulmonary infection. Cryptococcal meningitis requ ires an intense initial therapy. New therapy strategies were developed combining azoles with standard antimycotic drugs. The value of amphot ericin B in liposomal or lipid complex formulations is still undetermi ned due to the up to now low number of AIDS patients treated. Followin g initial therapy of cryptococcosis in AIDS a lifelong maintenance the rapy is essential. Fluconazole and itraconazole are appropriate drugs in this strategy.