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last
update October 2002
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| Fungal
infections |
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Candida
commonly causes mucocutaneous manifestations in HIV, such as thrush,
esophagitis, and vaginitis. Mucocutaneous candidiasis rarely becomes
invasive and does not need primary prophylaxis.
Prophylaxis with fluconazole does decrease the incidence of invasive
fungal disease, particularly cryptococcocis. Invasive disease
occurs primarily at CD4 counts below 75 cells/mm3.
Primary prophylaxis is not recommended because the two-year incidence
of invasive disease with these fungi (cryptococcosis, histoplasmosis,
coccidioidomycosis) is relatively low (<10%), the medication is
expensive, and therapy can select out resistant infection with
Candida species and torulopsis yeasts. There is a standard recommendation
for secondary prophylaxis, or maintenance therapy, once a patient
has had invasive fungal disease. |
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