Vazquez Jose A
Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
Drugs. 2003;63(10):971-89. doi: 10.2165/00003495-200363100-00004.
Oesophageal candidiasis is frequently one of the first signs of HIV infection, and a marker of HIV disease. Approximately 10% of patients with AIDS or other immunodeficiency, whether due to an underlying disease, chemotherapy or radiation therapy, will experience oesophageal candidiasis during their lifetime. In addition, unless the underlying immunodeficiency is corrected, approximately 60% of patients will experience a relapse within 6 months of the initial infection. The systemic azoles have gradually replaced the use of amphotericin B for oesophageal candidiasis, and are generally safely used and effective agents for this infection. A concern in some of these patients is the appearance of antifungal-refractory oesophageal candidiasis, which frequently leads to a vicious cycle of poor oral intake, weight loss, malnutrition and wasting syndrome, with occasional mortality due to malnutrition. Newer antifungals such as voriconazole and caspofungin, which are more potent in vitro and have a broader spectrum of activity, including activity against fluconazole-resistant Candida species are a welcome addition to the antifungal armamentarium that may be used in the management of refractory mucosal candidiasis.
食管念珠菌病常常是HIV感染的早期体征之一，也是HIV疾病的一个标志。约10%的艾滋病患者或其他免疫缺陷患者，无论病因是基础疾病、化疗还是放疗，在其一生中都会发生食管念珠菌病。此外，除非潜在的免疫缺陷得到纠正，约60%的患者在初次感染后6个月内会复发。全身用唑类药物已逐渐取代两性霉素B用于治疗食管念珠菌病，并且通常是治疗这种感染的安全有效药物。部分此类患者存在的一个问题是出现抗真菌治疗无效的食管念珠菌病，这常常导致口服摄入减少、体重减轻、营养不良和消耗综合征的恶性循环，偶尔会因营养不良导致死亡。新型抗真菌药物如伏立康唑和卡泊芬净，在体外活性更强且抗菌谱更广，包括对氟康唑耐药念珠菌属有活性，它们是抗真菌药物库中受欢迎的补充药物，可用于治疗难治性黏膜念珠菌病。
