Article type
Year
Abstract
Background: Oral candidiasis (OC) associated with human immunodeficiency virus (HIV) infection occurs commonly and recurs frequently, often presenting as an initial manifestation of the disease. Left untreated, lesions contribute to the morbidity associated with HIV/AIDS.
Objective: To evaluate current evidence about interventions for prevention and management of OC in HIV-infected adults and children.
Methods: Randomised controlled clinical trials of any intervention aimed at preventing, treating or palliating HIV-associated OC were considered. Outcome measures included clinical presence or absence of lesions, lesion severity and microbiological measures.
Results: Thirty-nine trials were identified and 28 met our inclusion criteria. Nineteen included trials investigated treatment and nine OC prevention. One study investigated OC in children 7 weeks to 14 years old. Trials were conducted in different countries, population groups and socio-economic settings.
Treatment success was determined in the majority of trials by assessing both clinical and mycological cure. Compared with ketoconazole and itraconazole, fluconazole improved clinical cure by 27% (2 trials; 83 participants; RR 1.27; 95% CI 0.97 to 1.66) and by 12% (3 trials; 474 participants; RR 1.12; 95% CI 0.92 to 1.36) respectively. Fluconazole clearly improved clinical cure when compared to nystatin (1 trial, 167 participants; RR 1.69; 95% CI 1.27 to 2.23). Similarly ketoconazole was superior to nystatin (1 trial, 92 participants; RR 5.22; 95% CI 1.21 to 22.53). Compared to clotrimazole both fluconazole (2 trials, 358 participants; RR 1.47; 95% CI 1.16 to 1.87) and itraconazole (1 trial; 123 participants; RR 2.20; 95% CI 1.43 to 3.39) significantly increased mycological cure.
Prevention was defined as reduction of the number of clinical episodes, i.e. prevention of recurrence while receiving prophylaxis. Fluconazole significantly reduced clinical episodes compared to placebo (5 trials; 599 participants; RR=0.61; 95%CI:0.5 to 0.74) or no treatment (1 trial; 65 participants; RR=0.16; 95%CI: 0.08 to 0.34). Continuously administered fluconazole was a more effective preventive measure than intermittent dosing.
Conclusions: Our results suggest that for prevention, fluconazole is the drug of choice. Ketoconazole, fluconazole and itraconazole all improved treatment outcomes. More research on treatment of OC in children is needed. Standardised scoring systems for clinical description of lesions need evaluation.
Objective: To evaluate current evidence about interventions for prevention and management of OC in HIV-infected adults and children.
Methods: Randomised controlled clinical trials of any intervention aimed at preventing, treating or palliating HIV-associated OC were considered. Outcome measures included clinical presence or absence of lesions, lesion severity and microbiological measures.
Results: Thirty-nine trials were identified and 28 met our inclusion criteria. Nineteen included trials investigated treatment and nine OC prevention. One study investigated OC in children 7 weeks to 14 years old. Trials were conducted in different countries, population groups and socio-economic settings.
Treatment success was determined in the majority of trials by assessing both clinical and mycological cure. Compared with ketoconazole and itraconazole, fluconazole improved clinical cure by 27% (2 trials; 83 participants; RR 1.27; 95% CI 0.97 to 1.66) and by 12% (3 trials; 474 participants; RR 1.12; 95% CI 0.92 to 1.36) respectively. Fluconazole clearly improved clinical cure when compared to nystatin (1 trial, 167 participants; RR 1.69; 95% CI 1.27 to 2.23). Similarly ketoconazole was superior to nystatin (1 trial, 92 participants; RR 5.22; 95% CI 1.21 to 22.53). Compared to clotrimazole both fluconazole (2 trials, 358 participants; RR 1.47; 95% CI 1.16 to 1.87) and itraconazole (1 trial; 123 participants; RR 2.20; 95% CI 1.43 to 3.39) significantly increased mycological cure.
Prevention was defined as reduction of the number of clinical episodes, i.e. prevention of recurrence while receiving prophylaxis. Fluconazole significantly reduced clinical episodes compared to placebo (5 trials; 599 participants; RR=0.61; 95%CI:0.5 to 0.74) or no treatment (1 trial; 65 participants; RR=0.16; 95%CI: 0.08 to 0.34). Continuously administered fluconazole was a more effective preventive measure than intermittent dosing.
Conclusions: Our results suggest that for prevention, fluconazole is the drug of choice. Ketoconazole, fluconazole and itraconazole all improved treatment outcomes. More research on treatment of OC in children is needed. Standardised scoring systems for clinical description of lesions need evaluation.