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Survival, relapse, and efficacy of prophylaxis (Pr) after candida esophagitis (CE) in AIDS.


Natl Conf Hum Retroviruses Relat Infect (1st). 1993 Dec 12-16;:138.

The course after AIDS-associated CE, and the efficacy of secondary prophylaxis, are undefined. Charts were reviewed of 21 patients (Pts) with a first episode of CE and close follow-up (f/u). There were 13 men/8 women, mean CD4 21 (range 3-83), who had CE diagnosed by typical signs and symptoms plus rapid response to oral azoles (Clinical cases;n=9) or confirmation by endoscopy or barium study (n=12). Clinical cases had more past thrush (p=.07) and opportunistic infections (OI)(p=.09), but were similar otherwise including risk of relapse (7/9 vs 6/12 confirmed Pts). Mean f/u was 9.0 (range 2-24) months (mos). 11 Pts were known to have died. Remaining alive correlated with CE as a presenting HIV illness (RR 3.0;95% CI 1.2-7.3;p=.02). Kaplan-Meier (K-M) survival was 75% at 7.5 mos; 50% at 10.5 mos; 25% at 14 mos. Azole (AZ) Pr (fluconazole or ketoconazole) was given to 13 pts. NON-AZ Pr included ZDV or ddI in 5 Pts, topical antifungals in 3, none in 2. 13/21 (62%) Pts had 17 relapses (3/13 first relapses confirmed). Relapse correlated with f/u time (11.6 vs 4.6 mos;p=.007), death during f/u (RR 3.0;CI 1.2-8.0;p=.008), past OI (RR 2.1;CI 1.1-4.3;p=.07), lower hemoglobin (p=.08) and NON-AZ Pr (RR 4.3;CI 0.64-28.8;p=.09). K-M relapse-free survival (RFS) on any Pr was 50% at 26 weeks (wks), 10% at 51 wks. RFS was 50% at 33 wks on AZ Pr but 14 wks on NON-AZ Pr. Trends of RFS in favor of AZ Pr were present at 10 wks (logrank p=.25) and 16 wks (p=0.1), but were lost by 37 wks. Survival rapidly declines in the 2nd 6-months after diagnosis of CE. Relapse-free survival declines steadily in the first year, associated with length of follow-up, chance of death, and past HIV complications. Oral azoles appear to prevent relapse only temporarily.

Adult Amphotericin B/THERAPEUTIC USE Candida/DRUG EFFECTS Candidiasis/*COMPLICATIONS Case Report CD4 Lymphocyte Count Drug Resistance, Microbial Esophagitis/*COMPLICATIONS Fluconazole/PHARMACOLOGY/*THERAPEUTIC USE Human HIV Infections/*COMPLICATIONS Male ABSTRACT


Information in this article was accurate in December 30, 1995. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.