TY - JOUR
T1 - Refractory mucosal candidiasis in advanced human immunodeficiency virus infection
AU - Fichtenbaum, Carl J.
AU - Koletar, Susan
AU - Yiannoutsos, Constantin
AU - Holland, Fiona
AU - Pottage, John
AU - Cohn, Susan E.
AU - Walawander, Ann
AU - Frame, Peter
AU - Feinberg, Judith
AU - Saag, Michael
AU - Van der Horst, Charles
AU - Powderly, W. G.
N1 - Funding Information:
From the 1Washington University School of Medicine, St. Louis, Missouri; 2Harvard School of Public Health, Cambridge, Massachusetts; 3Rush Medical College, Chicago, Illinois; 4University of Rochester School of Medicine, New York, and 5Frontier Science Technology Research Foundation, Buffalo, New York; 6Ohio State University School of Medicine, Columbus, and 7University of Cincinnati College of Medicine, Ohio; 8University of Alabama–Birmingham School of Medicine; 9University of North Carolina School of Medicine, Chapel Hill
Funding Information:
Received 4 May 1999; revised 17 August 1999; electronically published 28 April 2000. Grant support: National Institutes of Health (AI-25903). The institutional review board at each participating site approved the study, and written informed consent was obtained from all patients. a Current affiliations: University of Cincinnati College of Medicine, Cincinnati, Ohio (C.F.); Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom (F.H.); Vertex Pharmaceuticals, 130 Waverly Street, Cambridge, Massachusetts (J.P.). b List of additional contributors appears at the end of text. Reprints or correspondence: Dr. Carl Fichtenbaum, University of Cincinnati Medical Center, Holmes Division, Infectious Diseases Center, Eden and Bethesda Avenues, Cincinnati, OH 45267-0405 (carl.fichtenbaum@uc .edu).
PY - 2000
Y1 - 2000
N2 - We conducted a multicenter, prospective study of the risk factors, natural history, and outcome of fluconazole-refractory mucosal candidiasis (FRMC) in 832 persons with advanced human immunodeficiency virus (HIV) infection (median CD4 cell count, 14/mm3) during 1994-1996. FRMC was defined as mucosal candidiasis that failed to resolve despite 14 days of therapy with daily doses (200 mg) of fluconazole. Thirty-six persons (4.3%) had FRMC (35, oral; 1, esophageal), for an incidence of 4.2 per 100 person-years (859.7 total years of follow-up). In a multivariate model, the use of trimethoprim-sulfamethoxazole within 6 months of enrollment (relative risk [RR], 2.39; P = .04) and the use of fluconazole daily or every other day (RR, 5.64; P = .004) were significantly associated with the development of FRMC. The median survival after the development of FRMC was 32.6 weeks. In conclusion, the annual incidence of FRMC was <5%. Refractory candidiasis was a poor prognostic indicator. Daily or every-other-day use of fluconazole was associated with the development of refractory infection.
AB - We conducted a multicenter, prospective study of the risk factors, natural history, and outcome of fluconazole-refractory mucosal candidiasis (FRMC) in 832 persons with advanced human immunodeficiency virus (HIV) infection (median CD4 cell count, 14/mm3) during 1994-1996. FRMC was defined as mucosal candidiasis that failed to resolve despite 14 days of therapy with daily doses (200 mg) of fluconazole. Thirty-six persons (4.3%) had FRMC (35, oral; 1, esophageal), for an incidence of 4.2 per 100 person-years (859.7 total years of follow-up). In a multivariate model, the use of trimethoprim-sulfamethoxazole within 6 months of enrollment (relative risk [RR], 2.39; P = .04) and the use of fluconazole daily or every other day (RR, 5.64; P = .004) were significantly associated with the development of FRMC. The median survival after the development of FRMC was 32.6 weeks. In conclusion, the annual incidence of FRMC was <5%. Refractory candidiasis was a poor prognostic indicator. Daily or every-other-day use of fluconazole was associated with the development of refractory infection.
UR - https://www.scopus.com/pages/publications/0033807041
U2 - 10.1086/313765
DO - 10.1086/313765
M3 - Article
C2 - 10816143
AN - SCOPUS:0033807041
SN - 1058-4838
VL - 30
SP - 749
EP - 756
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 5
ER -