OPPORTUNISTIC CANDIDAL INFECTIONS IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - PREVENTION ISSUES AND PRIORITIES

Mucosal candidiasis (oropharyngeal, esophageal, and vulvovaginal candi diasis) has been among the most prominent opportunistic infections in persons infected with human immunodeficiency virus (HIV). Esophageal c andidiasis, an AIDS-defining illness, accounted for 15% of the AIDS-de fining illnesses in adults and adolescents diagnosed in the United Sta tes through 1992. The diagnosis of oropharyngeal and vaginal candidias is is based on clinically consistent signs and symptoms and a positive culture or a positive gram, KOH, or calcofluor stain, whereas the dia gnosis of esophageal and pulmonary candidiasis is based on histopathol ogy. Although a prospective controlled trial showed that prophylaxis w ith fluconazole can reduce the risk of mucosal candidiasis in patients with advanced HIV disease, routine primary prophylaxis is not recomme nded because of the effectiveness of therapy for acute disease, the lo w mortality associated with mucosal candidiasis, the potential for dev elopment of drug-resistant candidal infection, and the cost of prophyl axis. The probability of recurrences increases as CD4 counts decline. Nonetheless, many experts do not recommend chronic prophylaxis to prev ent recurrent oropharyngeal and vulvovaginal candidiasis, for the same reasons that primary prophylaxis is not recommended. However, if recu rrences are frequent or severe following documented esophageal candidi asis, long-term suppressive therapy with fluconazole should be conside red.