Treatment of mucosal candidiasis in HIV-infected patients

Mucosal candidiasis is the most common complication of human immunodeficiency virus (HIV) infection, affecting almost all patients at some point during their disease. As the CD4 lymphocyte count falls, especially beyond 300 cells/mm³, the risk of Candida oropharyngeal disease steadily increases. Subsequently, relapse is frequent regardless of HIV stage. Oropharyngeal candidiasis is itself a poor prognostic sign in this population, predicting increased risk of HIV progression and AIDS-defining illness. Symptomatic esophageal candidiasis becomes common as the CD4 count drops below 50 to 100 cells. As a result, Candida esophagitis accounts for 15% of initial AIDS-defining illnesses in adults and adolescents in the United States. This article will review treatment options for mucosal candidiasis, including fluconazole-sensitive mucosal candidiasis, fluconazole-resistant candidiasis, and the role of amphotericin B in this population.