A systematic review of the management of oral candidiasis associated with HIV/AIDS

[摘要] ENGLISH ABSTRACT:The purpose of this review was to investigate the management of oral candidiasis inHIV/AIDS patients and to evaluate the different guidelines that are available for itsmanagement. To achieve this aim, three objectives were identified: (i) to identify andreport on the different interventions used to manage oral candidiasis, in patients withHIV/AIDS, (ii) to determine the efficacy of these interventions, and (iii) to provideguidelines for management. A thorough systematic search of the literature was carriedout and all relevant papers were graded into three levels of evidence (A, B, and C) andscored for quality according to set criteria.A number of topical and systemic antifungal medications are used to treat oralcandidiasis in HIV-positive patients. These include the poleyne antibiotics, nystatin andamphotericin B. Milder episodes of oral candidiasis respond to topical therapy withnystatin, clotrimazole troches or oral ketoconazole. Fluconazole has been extensivelyevaluated as a treatment for candidiasis. With HIV-infection, a cure rate of 82% hasbeen achieved with a daily oral dose of 50 mg. Fluconazole was found to be a betterchoice of treatment for relapsing oropharyngeal candidiasis, resulting in either bettercure rates or better prevention of relapse. Intravenous amphotericin B has been found tobe effective therapy in azole refractory candidiasis where it was shown to be safe andwell tolerated.Topical therapies were found to be effective treatment for uncomplicated oropharyngealcandidiasis, however patients relapsed more quickly than those treated with oralsystemic antifungal therapy. Overall, nystatin appears less effective than clotrimazoleand the azoles in the treatment of oropharyngeal candidiasis. With regard to the resolution of clinical symptoms, clotrimazole was found to be just as effective asthe azoles, except when patient compliance was poor. Fluconazole-treated patients weremore likely to remain disease-free during the fluconazole follow-up period than withthose treated with other interventions.Relatively few studies were qualified to address the provision of guidelines for themanagement of oral candidiasis in primary health care settings. Most of the studiesfound were of moderate and low quality level of evidence. These studies included theassessment of different guidelines for identification, treatment and dental needs. Theystressed that patients with HN need dentists who will act as primary health careproviders, together with other providers to ensure adequate overall care.Given the level of interest and importance of candidiasis associated with treatment ofHN -positive patients, it is surprising to find that little high quality research has beenundertaken. As such, it is hoped that this review would provide researchers, oral healthcare workers and other health care providers with an overview of the management oforal candidiasis associated with HN/AIDS.

[发布机构] Stellenbosch University