Powderly W G
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri 63110.
AIDS Res Hum Retroviruses. 1994 Aug;10(8):925-9. doi: 10.1089/aid.1994.10.925.
Mucosal (oropharyngeal, esophageal, and, in women, vaginal) candidiasis is a common infectious complication in HIV-infected patients. There is a wide range of drugs to treat or suppress Candida infections. However, with the increasingly common use of fluconazole as treatment or prophylaxis in patients with relatively advanced HIV disease, mucosal candidiasis that is clinically resistant to fluconazole is increasingly recognized. Susceptibility testing for fluconazole has not been well standardized, and laboratory and clinical correlations often have been difficult to demonstrate. However, the frequency with which Candida strains resistant to fluconazole can be isolated appears to be increasing, particularly in patients with advanced HIV disease. Anecdotal results suggest that patients who fail fluconazole therapy usually do not respond to higher doses of fluconazole, but may occasionally respond to itraconazole or ketoconazole. In vitro susceptibility to these agents does not necessarily ensure clinical efficacy. Amphotericin B is usually effective initially but requires parenteral administration. However, with any therapy, relapses tend to occur and progressively recalcitrant disease often occurs, with increasing morbidity for patients. There is a clear need for studies addressing the incidence of resistance, the risk factors for its development, and more effective therapy.
黏膜念珠菌病（口咽、食管，女性为阴道念珠菌病）是HIV感染患者常见的感染并发症。有多种药物可用于治疗或抑制念珠菌感染。然而，随着氟康唑在相对晚期HIV疾病患者中越来越普遍地用作治疗或预防药物，临床上对氟康唑耐药的黏膜念珠菌病越来越受到关注。氟康唑的药敏试验尚未得到很好的标准化，实验室与临床之间的相关性往往难以证实。然而，对氟康唑耐药的念珠菌菌株的分离频率似乎在增加，尤其是在晚期HIV疾病患者中。轶事性结果表明，氟康唑治疗失败的患者通常对更高剂量的氟康唑无反应，但偶尔可能对伊曲康唑或酮康唑有反应。对这些药物的体外敏感性不一定能确保临床疗效。两性霉素B通常最初有效，但需要胃肠外给药。然而，无论采用何种治疗方法，复发往往都会发生，并且经常会出现逐渐难治的疾病，患者的发病率也会增加。显然需要开展研究来解决耐药的发生率、其发生的危险因素以及更有效的治疗方法。
