Oropharyngeal candidiasis in patients with HIV: Suggested guidelines for therapy

The high frequency of oropharyngeal candidiasis in immunocompromised patien ts has led many institutions to develop protocols to guide the use of antif ungal agents in the treatment of this opportunistic infection. However, few specific recommendations have been made for directing the management of or opharyngeal candidiasis in patients infected with HIV, To meet this need, a panel of experts representing a variety of disciplines met to formulate a consensus and devise a treatment strategy for clinical application. Among o ther recommendations, the algorithm calls for use of a topical agent for th e treatment of initial and recurring oropharyngeal candidiasis in HIV-infec ted patients, provided there is no esophageal involvement, patients' CD4(+) lymphocyte cell count is >50 cells/mm(3), and they are currently receiving or expected to receive effective antiretroviral treatment. For episodes of oropharyngeal candidiasis with concurrent esophageal involvement or where patients have a CD4(+) cell count of <50 cells/mm(3), are not receiving or anticipating highly active antiretroviral therapy (HAART), and have a high viral load, the algorithm suggests a systemic oral azole as the more approp riate treatment choice. Acute treatment of all oropharyngeal candidiasis ep isodes is preferred. Chronic suppressive antifungal treatment is to be avoi ded in recognition of the potential for the development of drug-resistant i nfection.