Long-term treatment with fluconazole in people with HIV does not increase the risk of developing resistant candidiasis
Prophylactic use of fluconazole in HIV-infected patients is intended to reduce the risk of developing fungal infections. However, using this medication prophylactically is associated with the risk of developing fungal infections resistant to fluconazole. As the results of a randomized controlled trial have shown, the likelihood of developing resistance during long-term treatment with fluconazole in HIV-infected patients does not exceed that of episodic prescriptions for this drug.
During the study, HIV-infected patients with CD4 + lymphocytes less than 150 cells / mm3 and a history of oropharyngeal candidiasis were randomized into two groups: the first group (n = 413) received continuous fluconazole therapy (200 mg 3 times a week); the second group (n = 416) received fluconazole sporadically (i.e. only during episodes of oropharyngeal candidiasis or esophageal candidiasis).
At the end of the 42-month study period, the development of fluconazole-resistant oropharyngeal candidiasis or esophageal candidiasis was recorded in 17 patients (4.1%) in the first group and in 18 patients (4 , 3%) from the second group. There was no difference between the two groups in terms of development of fluconazole-resistant infections over a 24-month period or before the end of the study. Continued use of fluconazole has been associated with fewer cases of oropharyngeal candidiasis or esophageal candidiasis (0.29 vs 1.08 episodes / patient per year in groups 1 and 2, respectively ; p less than 0.0001) and invasive fungal infections (15 vs 28 episodes in groups 1 and 2, respectively; p = 0.04), but was not associated with an increase survival versus episodic fluconazole therapy.
Long-term fluconazole therapy is not fully justified in developed countries, where fungal infections are rare, according to the researchers. However, in hospitals where highly active antiretroviral therapy is less available, mortality from fungal infections may be high and prophylactic use of fluconazole has shown increased survival.