REFRACTORY MUCOSAL CANDIDIASIS IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Difficult-to-manage mucosal candidal infection has been a hallmark of individuals with advanced infection due to human immunodeficiency viru s type 1. In this AIDS Commentary, Drs. Fichtenbaum and Powderly compr ehensively review the literature and their experience with refractory candidiasis in such patients. Of interest is their delineation of resi stance, a lack of susceptibility to an antifungal agent in vitro among patients with refractory or clinically unresponsive disease. These au thors believe that the establishment of resistance should be based upo n standards established by the National Committee on Clinical Laborato ry Standards, which they propose to define as a failure to respond to systematic therapy with specific doses of itraconazole, fluconazole, o r parenterally or orally administered amphotericin B within 14 days. T here have been many definitions of ''refractory candidiasis,'' and the one proposed by these authors will be debated; however, this definiti on has the advantage of establishing a standard by which to judge the efficacy of their proposed algorithm for the treatment of persistent o r refractory oropharyngeal candidal infections. Drs. Fichtenbaum and P owderly have performed a useful service in their attempt to bring cohe rence to the management of this common and often vexing problem.