Wilcox C M, Alexander L N, Clark W S, Thompson S E
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Gastroenterology. 1996 Jun;110(6):1803-9. doi: 10.1053/gast.1996.v110.pm8964406.
BACKGROUND & AIMS: The best initial treatment of human immunodeficiency virus (HIV)-infected patients with esophageal symptoms is unknown. The outcome, including safety and cost-effectiveness, of fluconazole compared with endoscopy as a treatment strategy for HIV-infected patients with new-onset esophageal symptoms was evaluated.
During a 53-month period, 134 HIV-infected patients with esophageal symptoms were randomized prospectively to groups receiving either standard doses of fluconazole or endoscopy.
Among the 68 patients in the fluconazole group, a complete symptomatic response was observed in 56 patients (82%), usually within 1 week. The most common endoscopic findings in the 66 patients in the endoscopy group included Candida esophagitis alone in 42 patients (64%) and ulcerative esophagitis in 10 patients (15%). Patients responding to empirical antifungal therapy or who had Candida esophagitis alone at endoscopy were less like to have severe symptoms (P = 0.027) or odynophagia as the only symptom (P < 0.001) but more frequently had odynophagia and dysphagia (P = 0.007) and thrush (P = 0.002). Empirical fluconazole was cost-effective, saving $738.16 per patient.
Empirical oral antifungal therapy with fluconazole is highly efficacious, safe, and cost-effective for HIV-infected patients with new-onset esophageal symptoms.
人类免疫缺陷病毒（HIV）感染且有食管症状的患者最佳初始治疗方法尚不清楚。我们评估了氟康唑与内镜检查作为HIV感染且新发食管症状患者治疗策略的疗效，包括安全性和成本效益。
在53个月期间，134例有食管症状的HIV感染患者被前瞻性随机分为接受标准剂量氟康唑组或内镜检查组。
氟康唑组68例患者中，56例（82%）通常在1周内出现完全症状缓解。内镜检查组66例患者中最常见的内镜检查结果包括42例（64%）单纯念珠菌食管炎和10例（15%）溃疡性食管炎。对经验性抗真菌治疗有反应或内镜检查仅发现念珠菌食管炎的患者出现严重症状（P = 0.027）或仅以吞咽痛为唯一症状（P < 0.001）的可能性较小，但更常出现吞咽痛和吞咽困难（P = 0.007）以及鹅口疮（P = 0.002）。经验性使用氟康唑具有成本效益，每位患者节省738.16美元。
对于有新发食管症状的HIV感染患者，经验性口服氟康唑抗真菌治疗高效、安全且具有成本效益。
