ABSTRACT
AIDS: An AIDS Clinical Trials Group study examined whether less intensive maintenance antiretroviral regimens could be effective after the initial use of highly active induction therapy. Results from 309 patients, who were evaluated in the maintenance phase, demonstrated that 6 months of therapy with AZT/3TC/IDV, followed by less intensive treatment, is not an effective strategy. Results suggest that once viral suppression has been achieved, intensity of therapy should not be lessened.^ieng
Subject(s)
Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , Indinavir/therapeutic use , Stavudine/therapeutic use , Zidovudine/therapeutic use , Anti-HIV Agents/administration & dosage , Drug Therapy, Combination , HIV Protease Inhibitors/administration & dosage , HIV Protease Inhibitors/therapeutic use , Humans , Indinavir/administration & dosage , Reverse Transcriptase Inhibitors/administration & dosage , Reverse Transcriptase Inhibitors/therapeutic use , Stavudine/administration & dosage , Zidovudine/administration & dosageABSTRACT
A cross-sectional study was conducted to assess the prevalence and microbiology of oral infection due to fluconazole-resistant Candida in patients with AIDS. Oral swab specimens for fungal cultures were obtained from 100 consecutive outpatients with CD4 lymphocyte counts of < 200/mm3. At least one fungal organism demonstrating in vitro resistance to fluconazole (minimum inhibitory concentration, > or = 8 micrograms/mL) was isolated from 26 (41%) of 64 patients for whom cultures were positive. When fluconazole-resistant C. albicans was isolated, in vitro resistance correlated with clinical thrush. None of 10 patients from whom only non-albicans species of Candida were isolated had active thrush. The patients from whom fluconazole-resistant Candida albicans was isolated had lower CD4 cell counts (median, 9/mm3), a greater number of treated episodes of thrush (median, 4.5), and a greater median duration of prior fluconazole treatment (231 days) than did patients from whom fluconazole-susceptible C. albicans was isolated (median CD4 cell count, 58/mm3 [P = .004]; median number of treated episodes of thrush, 2.0 [P = .001]; and median duration of prior fluconazole treatment, 10 days [P = .01]; respectively). In a multivariate analysis, the number of episodes and duration of fluconazole therapy were independent predictors of resistance.
Subject(s)
Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/microbiology , Antifungal Agents/therapeutic use , Candidiasis, Oral/drug therapy , Candidiasis, Oral/epidemiology , Fluconazole/therapeutic use , Antifungal Agents/administration & dosage , CD4 Lymphocyte Count , Candida/drug effects , Candida/isolation & purification , Cross-Sectional Studies , Drug Resistance, Microbial , Female , Fluconazole/administration & dosage , Humans , Male , Microbial Sensitivity Tests , Multivariate Analysis , Prevalence , Recurrence , Time FactorsABSTRACT
In a case-control study to identify risk factors for fluconazole-resistant oroesophageal candidiasis in human immunodeficiency virus-infected patients, 25 patients with clinical and in vitro fluconazole-resistant candidiasis were paired with controls who had treatment-responsive candidiasis and who had been observed for similar time periods. After their first episode of candidiasis, patients who later developed fluconazole resistance had more treated episodes than did matched controls (cases, 3.1; controls, 1.8; P = .004), lower median CD4 cell counts (11/mm3 vs. 71/mm/3; P = .004), and greater median durations of all antifungal therapy (419 vs. 118 days; P < .001) and of systemic azole therapy (272 vs. 14 days; P < .001). When paired with a second set of controls matched by CD4 cell count as well as first diagnosis of candidiasis, cases continued to show greater median exposure to azoles (272 vs. 88 days; P = .005). These data indicate that advanced immunosuppression and exposure to oral azoles are risk factors for the development of fluconazole resistance.
