Lin Jiong, Peng Cai-Xia, Huang Wei-Man
Department of Stomatology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen 518100, Shenzhen, China.
Department of Stomatology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen 518100, Shenzhen, China.
Med Clin (Barc). 2025 Jan 24;164(2):76-83. doi: 10.1016/j.medcli.2024.05.018. Epub 2024 Aug 29.
Oral candidiasis infection is particularly prevalent among individuals in HIV-positive patients. Antifungal drugs have shown promising therapeutic effects in treating oral candidiasis in HIV-positive patients. However, the selection of specific antifungal drugs for the treatment of oral candidiasis in HIV-positive patients lacks evidence-based guidelines. This study aims to address this gap by conducting a comprehensive review of relevant randomized controlled trials (RCTs) and performing a network meta-analysis to assess the efficacy of different antifungal drugs in treating oral candidiasis in HIV-positive patients. A systematic search was conducted in databases including EMBASE, Web of Science, Medline, and Cochrane databases to identify relevant articles. Additionally, key pertinent sources in the literatures were also reviewed. All studies published prior to August 2023 were eligible for inclusion. Two researchers independently conducted the screening of literature, extraction of data, and evaluation of quality. Pairwise and network meta-analysis were then performed to assess the primary outcomes of the randomized controlled trials (RCTs) included. The protocol was registered on the PROSPERO database (CRD42024513912). Twenty-six RCTs were included in this meta-analysis, involving a total of 3145 patients and evaluating seven interventions (placebo, fluconazole, itraconazole, nystatin, clotrimazole, ketoconazole, miconazole). Pairwise meta-analysis and network meta-analysis showed fluconazole was significantly efficacy in increasing mycological cure rates when compared with placebo, clotrimazole, and nystatin. Ketoconazole and miconazole were significantly efficacy in increasing mycological cure rates when compared with nystatin. Network meta-analysis also suggested the efficacy of the seven interventions in increasing mycological cure rates was ranked as follows: placebo (35.3%), fluconazole (95.2%), itraconazole (61.6%), nystatin (17.0%), clotrimazole (52.7%), ketoconazole (69.2%), miconazole (69.1%). The available evidence indicates that fluconazole had the greatest possibility to increase mycological cure rates in HIV-positive patients, while, nystatin was the least effective antifungal drug in increasing mycological cure rates in HIV-positive patients.
口腔念珠菌感染在HIV阳性患者中尤为普遍。抗真菌药物在治疗HIV阳性患者的口腔念珠菌病方面已显示出有前景的治疗效果。然而，针对HIV阳性患者口腔念珠菌病治疗选择特定抗真菌药物缺乏循证指南。本研究旨在通过对相关随机对照试验（RCT）进行全面综述并开展网状Meta分析，以评估不同抗真菌药物治疗HIV阳性患者口腔念珠菌病的疗效。在包括EMBASE、科学网、Medline和Cochrane数据库在内的数据库中进行系统检索，以识别相关文章。此外，还对文献中的关键相关来源进行了综述。2023年8月之前发表的所有研究均符合纳入标准。两名研究人员独立进行文献筛选、数据提取和质量评估。然后进行成对和网状Meta分析，以评估纳入的随机对照试验（RCT）的主要结局。该方案已在PROSPERO数据库（CRD42024513912）上注册。本Meta分析纳入了26项RCT，共涉及3145名患者，评估了七种干预措施（安慰剂、氟康唑、伊曲康唑、制霉菌素、克霉唑、酮康唑、咪康唑）。成对Meta分析和网状Meta分析表明，与安慰剂、克霉唑和制霉菌素相比，氟康唑在提高真菌学治愈率方面具有显著疗效。与制霉菌素相比，酮康唑和咪康唑在提高真菌学治愈率方面具有显著疗效。网状Meta分析还表明，七种干预措施在提高真菌学治愈率方面的疗效排名如下：安慰剂（35.3%）、氟康唑（95.2%）、伊曲康唑（61.6%）、制霉菌素（17.0%）、克霉唑（52.7%）、酮康唑（69.2%）、咪康唑（69.1%）。现有证据表明，氟康唑在提高HIV阳性患者真菌学治愈率方面可能性最大，而制霉菌素是提高HIV阳性患者真菌学治愈率方面效果最差的抗真菌药物。
