Abstract

PIP: In 1987, data from the Centers for Disease Control AIDS data base indicated a 50% prevalence of oropharyngeal Candida infection, a 10% rate of esophageal infection, and .5% rate of bronchopulmonary infection among AIDS patients. Candida-positive blood cultures were found in 13 of 903 AIDS patients, and disseminated Candida infection was ascertained in 11 of 101 post mortem examinations of AIDS victims. 5 of 12 patients with oral Candida infection progressed to AIDS within a 42-week investigation as opposed to only 1 of 17 patients without Candida. In the former group, CD4 counts and CD4/CD8 ratios were also significantly lower. Most infections were caused by Candida albicans. Genital Candida occurs in 5-20% of women in reproductive age. In a study of 66 HIV-infected women Candida vaginitis preceded oral Candida infections which preceded Candida esophagitis. 33 women had vaginal infection, 25 had oral Candida, and 9 had esophageal infection with reduced CD4 counts. Infections of the oropharynx and the vagina are reduced CD4 counts. Infections of the oropharynx and the vagina are treated with amphotericin B, nystatin, miconazole, and clotrimazole. Systemically effective compounds include ketoconazole, itraconazole, and fluconazole, although interactions with rifampicin, phenobarbital, and phenytoin used in HIV treatment occur. Fluconazole is contraindicated in C. glabrata and C. krusei infections as it selects for azole-resistant Candida strains. Iv amphotericin B and fluconazole are used in serious infections when oral treatment is ineffective.