Special patient populations: onychomycosis in the HIV-positive patient.

Superficial fungal infections, including onychomycosis, have become an increasing problem as the number of patients with HIV infection or AIDS has grown. Superficial fungal infections and other cutaneous and noncutaneous disorders are correlated with a decline in the patient's CD4 cell count and are markers of disease progression. For those HIV-positive patients with fungal nail infections, the introduction of the new triazole antifungal agents (e.g., itraconazole, fluconazole) has markedly improved the therapeutic outcome. Unlike traditional topical or oral antifungal therapies, whose clinical utility was limited by relatively poor efficacy and the need for prolonged treatment, the new triazoles fulfill one of the foremost goals of HIV-infected patients: rapid symptomatic improvement of onychomycosis. For many patients, particularly those who live in areas with a high incidence of HIV, the psychologic rewards associated with the alleviation of this unsightly and "telltale" condition are immeasurable.