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Clinical and mycological evaluation of fluconazole in the secondary prophylaxis of esophageal candidiasis in AIDS patients

An open, multicenter study

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Abstract

A prospective, multicenter, open study of fluconazole prophylaxis was performed in AIDS patients to evaluate the efficacy and toxicity of the drug in preventing relapses of esophageal candidiasis. To this aim, 99 AIDS patients who presented a first episode of clinically and microbiologically confirmed esophageal candidiasis were enrolled in eleven clinical centers scattered throughout the Italian territory. After resolution of this initial esophagitis, all subjects were given fluconazole, 100 mg/die, and followed up for a 6 month period. Only 7 out of the 99 patients enrolled had a relapse ofCandida esophagitis, during a mean follow-up period of 138.5 days. All relapsing patients had CD4+ cell number <100/µl at baseline. Mild side effects were reported in only eight patients. However, 14 of the 27 subjects from whom serial serum samples were available became (12) or remained (2) antigenemic during fluconazole prophylaxis, independently from relapse, suggesting the persistence of tissue-invasive, proliferatingCandida cells. Overall, the data of this study suggest a beneficial effect of prophylactic maintenance therapy with fluconazole againstCandida esophagitis, particularly in the population with >100 CD4+/µl. However, the data onCandida antigenemia in these patients invite the consideration of a relative inefficiency of the drug to eradicate the microrganism from the esophageal tissue.

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Correspondence to Dr A. Cassone.

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Agresti, M.G., de Bernardis, F., Mondello, F. et al. Clinical and mycological evaluation of fluconazole in the secondary prophylaxis of esophageal candidiasis in AIDS patients. Eur J Epidemiol 10, 17–22 (1994). https://doi.org/10.1007/BF01717446

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Key words

  • AIDS
  • Candida
  • Candidal esophagitis
  • Fluconazole prophylaxis
  • Italy