Treatment Review #18; April 1995
A recently completed study that compared clotrimazole to
fluconazole to prevent fungal infections showed that
fluconazole was more effective, particularly in people with
50 or fewer T4 cells. In addition, fluconazole was shown to
reduce the frequency of cryptococcal meningitis, esophageal
candidiasis, and superficial fungal infections. We updated
the following fungal infection fact sheet to include this new
information. It is still not recommended that all people take
preventive treatment for fungal infections due to the
possibility of resistance to treatment.
Thrush is the most common and least serious fungal infection
in HIV+ people. It can affect the mouth, throat, skin,
stomach, and vagina. In a person with a weakened immune
system, thrush can cause more serious problems. This
condition is sometimes called candidiasis, because the germs
that cause it are called candida albicans. Other types of
fungus have been discovered, however, so it may be necessary
to try different drugs besides the ones that are used now.
Some medications, such as antibiotics, steroids, and cancer
medications, may cause thrush.
Oral thrush (in the mouth) looks like white or red patches.
It can cause sore throat, pain when swallowing, and nausea.
It can also make you not want to eat, make eating painful,
and make food taste different. Treatments for oral thrush
include mouthwash and tablets called troches. Some people try
baking soda or hydrogen peroxide mixed with water to rinse
the mouth. If the thrush is advanced, this isn't likely to
work. Treatments for thrush include clotrimazole,
fluconazole, and ketoconazole. These drugs have different
brand names. These drugs sometimes lose their effects when
taken for long periods of time, but new ways to use these
drugs, and new drugs are being studied.
Some people try different home remedies. Using large amounts
of garlic, and avoiding foods which contain sugar, yeast or
dairy products are popular, although unproven ways to stop
the growth of thrush.
Vaginal candidiasis is a common yeast infection of the
vagina. Symptoms include severe itching, burning, and a thick
discharge, often white in color. It is possible that an
infection such as unrecognized tuberculosis may be causing a
vaginal yeast infection. Nystatin tablets are used for
treatment. Clotrimazole ointment is another treatment, which
is sold over-the-counter as Gyne-Lotrimin, Lotrimin or
Mycelex. Studies have shown that HIV-negative women only have
to take the drug Diflucan one time to treat this condition.
Always consult with your doctor before beginning any
Cryptococcal meningitis is a very serious fungal infection.
It is caused by a fungus found mainly in dirt and bird
droppings. Meningitis means swelling of the meninges. The
meninges cover the brain and spinal cord. Symptoms can be
hard to recognize as being caused by cryptococcal infection.
Watch for fever, vomiting, headache, nausea, fatigue, loss of
appetite, and a general feeling of not being well. Other
symptoms are a stiff neck and, infrequently, seizures.
Pneumonia may be an early sign of infection. Tell your doctor
about symptoms right away.
A treatment that can be given by pill, in some cases, or by
intravenous injection is fluconazole, or Diflucan. Most
people prefer this treatment because it causes few side
effects. Another common treatment for this condition is
amphotericin B, which must be given by intravenous injection.
Amphotericin B is used in more severe cases, as determined by
performing a lumbar puncture (spinal tap).
Histoplasmosis can be a life-threatening fungal infection and
commonly occurs in the Southwestern U.S. In the past,
histoplasmosis was treatable only with intravenous
amphotericin. Itraconazole is used today, although it may not
be effective for treating histoplasmosis involving the
central nervous system and brain, since it does not penetrate
well into the cerebrospinal fluid, which is the fluid that
surrounds the spinal cord and brain.
Blastomycosis is a fungal infection involving the lungs and
occasionally spreading to the skin. The fungus is of unknown
natural source. Most reported cases are from the southeastern
states and the Mississippi River valley, and occur in men
ages 20 to 40. When infection occurs in the lungs, a dry
hacking or productive cough, chest pain, fever, chills,
drenching sweats, and shortness of breath are initial
symptoms. If untreated, the disease slowly causes death.
Amphotericin B is highly effective. Improvement begins within
a week, with rapid disappearance of organisms.