Diagnosis and treatment of oropharyngeal candidiasis in patients infected with HIV: A critical reassessment

Oropharyngeal candidiasis is the most common opportunistic infection seen i n patients infected with the human immunodeficiency virus (HIV). As HIV dis ease progresses and immunosuppression worsens, the incidence and severity o f oropharyngeal candidiasis increase, The predominant pathogen in initial a nd recurrent episodes is Candida albicans, which responds to a variety of t opical (nystatin and clotrimazoie) and systemic azole antifungal agents (ke toconatole, itraconazole, and fluconazole), Since the introduction of the o ral azoles, increasing evidence indicates that C. albicans strains are deve loping resistance to azoles, particularly fluconazole, and other Candida st rains are emerging that are intrinsically less susceptible to azole therapy . The advent of effective antiretroviral therapies for the treatment of HIV disease has led to a scenario in which antifungal strategies are likely to be highly effective, To minimize the risk of resistance, topical therapies should be considered first-line candidates for treatment of initial or rec urrent cases of uncomplicated oropharyngeal candidiasis, Systemic azole the rapy should be reserved for cases unresponsive to topical therapies or for more severe oropharyngeal candidiasis with esophageal involvement.