PREVENTION OF SYMPTOMATIC RECURRENCES OF ESOPHAGEAL CANDIDIASIS IN AIDS PATIENTS AFTER THE FIRST EPISODE - A PROSPECTIVE OPEN STUDY

Objectives: To evaluate the efficacy and safety of low-dose antifungal s as prophylaxis of recurrent esophageal candidiasis after the first e pisode in patients with AIDS. Methods: After the first episode of esop hageal candidiasis, 122 consecutive AIDS patients were randomly assign ed to two different regimens of continuous longterm antifungal prophyl axis (ketoconazole 200 mg or fluconazole 50 mg/day p.o.) or no antifun gal therapy over a period of 2 yr. Patients were followed up by monthl y clinical controls and upper GI endoscopy in the case of recurrence o f esophageal symptoms. Results: One hundred and six patients were clin ically evaluable over a mean observation time of 7.5 months. Prophylax is with oral antifungals significantly reduced symptomatic relapses of esophageal candidiasis, the cumulative probability of relapse at 12 m onths being 38% in the prophylaxis group, compared with 84% in the unt reated group. Both antifungals were sufficiently safe and well tolerat ed. The clinical response of a second episode of candidiasis to the re introduction of standard oral antifungals was markedly worse in patien ts on prophylaxis (especially with ketoconazole) than in untreated pat ients, presumably due to the development of resistance to the antifung al. Conclusions: Continuous prophylaxis with both fluconazole and keto conazole is effective in preventing recurrences of Candida esophagitis in AIDS patients; however, the possible emergence of strains resistan t to these antifungals, as well as the high cost of the therapy, shoul d raise doubts as to whether or not this type of prophylaxis should be extended to all AIDS patients with Candida esophagitis, rather than t o limit its use to specific subgroups of patients, such as those with frequent symptomatic relapses.