Interventions for the prevention and management of oropharyngeal candidiasis associated with HIV infection in adults and children

Abstract

Implications for practiceDue to only one study in children it is not possible to make recommendations for treatment or prevention of OC in children. Amongst adults, there were few studies per comparison. Due to insufficient evidence no conclusion could be made about the effectiveness of clotrimazole, nystatin, amphotericin B, itraconazole or ketoconazole with regard to OC prophylaxis. In comparison to placebo, fluconazole is an effective preventative intervention. However, the potential for resistant Candida organisms to develop, as well as the cost of prophylaxis, might impact the feasibility of implementation. No studies were found comparing fluconazole with other interventions. Direction of findings suggests that ketoconazole, fluconazole, itraconazole and clotrimazole improved the treatment outcomes. Implications for researchThere is an urgent need for gentian violet and other less expensive anti-fungal drugs for OC treatment to be evaluated in larger studies. More well designed treatment trials with larger sample size are needed to allow for sufficient power to detect differences in not only clinical, but also mycological response and relapse rates. There is also a strong need for more research to be done on the treatment and prevention of OC in children as it is reported that OC is the most frequent fungal infection in children and adolescents who are HIV positive. More research on the effectiveness of less expensive interventions also needs to be done in resource-poor settings. Currently few trials report outcomes related to quality of life, nutrition, or survival. Future researchers should consider measuring these when planning trials. Development of resistance remains under-studied and more work must be done in this area. It is recommended that trials be more standardised and conform more closely to CONSORT as this will improve research and also clinical practice.

Miconazole Revisited: New Evidence of Antifungal Efficacy from Laboratory and Clinical Trials

“…Oral candidiasis treatment in HIV-infected groups has been described in two systematic reviews of the literature [20,21]. Interestingly, neither of these articles mentioned miconazole.…”

Candida infection in HIV positive patients 1985–2007

“…[1][2][3][4] This is a report on the changing patterns of disease caused by Candida species as observed in our clinic during the last 22 years. In the period from 1985 to 2006, a total of 9587 patients accounting for 15 011 hospitalisations were treated for HIV related conditions.…”

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

“…Concerns exist about the potential for resistant Candida strains, drug interactions between antifungal and antiretroviral (ARV) agents, and lack of randomized controlled trials in children. 20 …”