Refractory mucosal candidiasis in advanced human immunodeficiency virus infection

We conducted a multicenter, prospective study of the risk factors, natural history, and outcome of fluconazole-refractory mucosal candidiasis (FRMC) i n 832 persons with advanced human immunodeficiency virus (HIV) infection (m edian CD4 cell count, 14/mm(3)) during 1994-1996, FRMC was defined as mucos al candidiasis that failed to resolve despite 14 days of therapy with daily doses (greater than or equal to 200 mg) of fluconazole, Thirty-six persons (4.3%) had FRMC (35, oral; 1, esophageal), for an incidence of 4.2 per 100 person-years (859.7 total years of follow-up). In a multivariate model, th e use of trimethoprim-sulfamethoxazole within 6 months of enrollment (relat ive risk [RR], 2.39; P = .04) and the use of fluconazole daily or every oth er day (RR, 5.64; P = .004) were significantly associated with the developm ent of FRMC. The median survival after the development of FRMC was 32.6 wee ks. In conclusion, the annual incidence of FRMC was <5%. Refractory candidi asis was a poor prognostic indicator. Daily or every-other-day use of fluco nazole was associated with the development of refractory infection.