TreatmentUpdate79 - Vol. 7, No. 9;- July 1997
Sean Hosein

An infection caused by the fungus Candida, is called candidiasis. Such infections can cause discomfort and, indirectly, can lead to weight loss in PHAs. The fungus usually tends to attack the mouth, throat and vagina, though it can move from the throat further into the digestive tract. Although different regimens of the drug fluconazole can prevent these infections, everyday use of this drug for all PHAs is usually not recommended because of its high cost, the potential for drug interactions and the risk of developing fungal infections which may be resistant to fluconazole. Doctors in the US have recently published their results of a study using fluconaozle 200 mg/week to prevent the appearance of candidiasis in women with HIV infection. We report their findings below.

Study Details

Using code numbers instead of names, researchers assigned women to receive fluconazole or fake fluconazole (placebo). That way, neither researchers nor people in the study knew who received which product. The study enrolled 323 volunteers, half of whom had 180 CD4+ cells. Half the subjects in the fluconazole group remained in the study for 17 months while the equivalent figure for the placebo group was 10 months. The study lasted for about 30 months.

Results

* Fluconazole group - 44% developed candidiasis

* Placebo group - 58% developed candidiasis

This difference between the two groups was statistically significant, that is, not likely due to chance alone. Even women who had previously experienced candida infections received some protection from fluconazole. Interestingly, 6 subjects on weekly fluconazole and 7 on placebo developed candidiasis, which did not resolve itself when treated with fluconazole.

Deaths and toxicity

Forty percent of subjects died by the end of the study -- 68 in the fluconazole group and 60 in the placebo group. This difference was not statistically significant. Twenty-three subjects on placebo and 41 on fluconazole experienced "at least" one side effect, but doctors did not state which parts of the body were affected.

Overall, use of once weekly fluconazole appeared to be safe and effective in preventing candida infection in HIV+ women by approximately 50%, compared to subjects receiving fake fluconazole.

REFERENCES:

1. Schuman P, Capps L, Peng G, et al. Weekly fluconazole for the prevention of mucosal candidiasis in women with HIV infection: a randomized, double-blind, placebo-controlled trial. Annals of Internal Medicine 1997;126:689-969.

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