Mucocutaneous
candidiasis (MC) is one of the first signs of
HIV infection. In the pre-
highly active antiretroviral therapy (
HAART) era, more than 90% of patients with
HIV infection eventually developed some form of
oral candidiasis during their illness, and an additional 10% developed esophageal
candidiasis (EC). Although several
antifungal agents are available, systemic
azoles (e.g.,
fluconazole and
itraconazole) have replaced older topical antifungals (e.g.,
gentian violet and
nystatin) in the management of MC in these patients. Overall, the
azoles are safe and effective agents in HIV-infected patients with MC. However, clinical relapses are extremely common in HIV patients not on
HAART or who are noncompliant. The relapses are dependent on the degree of immunosuppression and are more common following treatment with
clotrimazole or
ketoconazole than with
fluconazole or
itraconazole.
Posaconazole is a new extended-spectrum
triazole recently approved for the management of oropharyngeal
candidiasis (OPC). In vitro,
posaconazole possesses potent activity against Candida species, including strains that are resistant to
fluconazole. Recent clinical trials demonstrate that
posaconazole is as efficacious as
fluconazole in producing a successful clinical response in HIV-infected patients with OPC/EC. In addition,
posaconazole has been demonstrated to be well tolerated and more effective in sustaining clinical success
after treatment was discontinued.
Posaconazole appears to be an effective alternative in the management of MC in these difficult-to-treat
infections.