A systematic review of the management of oral candidiasis associated with HIV/AIDS
On t.p.: Degree MSc Dental Science (Community Dentistry)
Thesis (MSc)--Stellenbosch University, 2002.
ENGLISH ABSTRACT: The purpose of this review was to investigate the management of oral candidiasis in HIV/AIDS patients and to evaluate the different guidelines that are available for its management. To achieve this aim, three objectives were identified: (i) to identify and report on the different interventions used to manage oral candidiasis, in patients with HIV/AIDS, (ii) to determine the efficacy of these interventions, and (iii) to provide guidelines for management. A thorough systematic search of the literature was carried out and all relevant papers were graded into three levels of evidence (A, B, and C) and scored for quality according to set criteria. A number of topical and systemic antifungal medications are used to treat oral candidiasis in HIV-positive patients. These include the poleyne antibiotics, nystatin and amphotericin B. Milder episodes of oral candidiasis respond to topical therapy with nystatin, clotrimazole troches or oral ketoconazole. Fluconazole has been extensively evaluated as a treatment for candidiasis. With HIV-infection, a cure rate of 82% has been achieved with a daily oral dose of 50 mg. Fluconazole was found to be a better choice of treatment for relapsing oropharyngeal candidiasis, resulting in either better cure rates or better prevention of relapse. Intravenous amphotericin B has been found to be effective therapy in azole refractory candidiasis where it was shown to be safe and well tolerated. Topical therapies were found to be effective treatment for uncomplicated oropharyngeal candidiasis, however patients relapsed more quickly than those treated with oral systemic antifungal therapy. Overall, nystatin appears less effective than clotrimazole and the azoles in the treatment of oropharyngeal candidiasis. With regard to the resolution of clinical symptoms, clotrimazole was found to be just as effective as the azoles, except when patient compliance was poor. Fluconazole-treated patients were more likely to remain disease-free during the fluconazole follow-up period than with those treated with other interventions. Relatively few studies were qualified to address the provision of guidelines for the management of oral candidiasis in primary health care settings. Most of the studies found were of moderate and low quality level of evidence. These studies included the assessment of different guidelines for identification, treatment and dental needs. They stressed that patients with HN need dentists who will act as primary health care providers, together with other providers to ensure adequate overall care. Given the level of interest and importance of candidiasis associated with treatment of HN -positive patients, it is surprising to find that little high quality research has been undertaken. As such, it is hoped that this review would provide researchers, oral health care workers and other health care providers with an overview of the management of oral candidiasis associated with HN/AIDS.
AFRIKAANSE OPSOMMING: Die doelstelling van die oorsig was om ondersoek in te stel na die hantering van orale kandidiase in HIV/AIDS pasiënte asook om die verskillende beskikbare riglyne vir die behandeling daarvan te evalueer. Ter verwesenliking van hierdie doelstelling is drie doelwitte geïdentifiseer: (i) om die intervensies wat gebruik word in die hantering van orale kandidiase behandeling te identifiseer, (ii) om die effektiwiteit van hierdie intervensies te identifiseer en (iii) om op grond hiervan riglyne vir die hantering voor te stel. 'n Sistematiese literatuursoektog is uitgevoer en alle relevante artikels is in drie groepe geklassifiseer (A, B en C) op grond van die data kwaliteit. 'n Verskeidenheid topikale en sistemiese antifungale middels word gebruik om orale kandidiase in HIV-positiewe pasiënte te behandel. 'n Sukseskoers van 82% is met die gebruik van 'n daaglikse dosis van 50 mg medikament gerapporteer. Fluconazole was die beter keuse van middel vir die behandeling van terugkerende orofaringeale kandidiase. Topikale behandeling was effektief in die behandeling van ongekompliseerde orofaringeale kandidiase, hoewel die kans op terugkeer van die toestand groter was as met die sistemiese middels. Pasiënte wat met flukonasool behandel is, het 'n groter kans gehad om siektevry te bly vergeleke met pasiënte op die ander intervensies. Meeste van die studies was van middelmatige tot lae kwaliteit en gevolglik was dit moeilik om behandelingsriglyne te stel. Wat egter wel duidelik is, is dat HIV pasiënte primêre mondsorg benodig wat saam met ander versorging omvattende sorg sal verseker.