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Gay Men's Health Crisis
Weekly Fluconazole to Prevent Candida
Dave Gilden
July 6, 1996
GMHC Treatment Issues 1996 Jun/Jul 6; 10(6/7): 3

Few of our survey respondents administered prophylaxis for fungal infections of any sort, although several noted that vaginal yeast infections ("candidiasis" caused by the yeast species Candida albicans) were a special problem for women with HIV. These specialists also noted that such women seemed to have more oral and esophageal candidiasis than HIV- positive men.

A recently concluded trial conducted in women by the government-sponsored Community Programs for Clinical Research on AIDS (CPCRA) has found that 200 mg of fluconazole taken weekly can cut the risk of developing oral/throat or vaginal yeast infections by half. The effect on yeast in the esophagus could not be determined because of its low rate of occurrence during the study.

This placebo-controlled trial, known as CPCRA 010, enrolled 323 women with CD4 counts less than 350 (average CD4 count: 199). The median time on study medication was sixteen months for those receiving fluconazole and ten months for those on placebo.

Use of fluconazole to prevent fungal or yeast infections has been widely shunned because of the risk of developing drug- resistant microbes. Such resistance would render fluconazole useless for the valuable treatment role it now performs. In CPCRA 010, however, the incidence of fluconazole-resistant candidiasis was low and equal in both the fluconazole and placebo arms. But although weekly fluconazole reduced the frequency with which Candida albicans was isolated in vaginal secretions, there was increased isolation of closely related, though less pathogenic species of yeast.

The researchers concluded that weekly fluconazole could have a useful role in preventing recurrent mucosal candida infection in women. In the study, women with a recent history of repeated vaginal candidiasis had a significantly higher risk of new episodes. The women who had previously had candida in the mouth, pharynx or esophagus were at higher risk for another infection in those areas, as were women who had AIDS or used one of the standard preventive drugs for Pneumocystis carinii pneumonia.