TIME-COURSE OF CLINICAL-RESPONSE WITH FLUCONAZOLE FOR CANDIDA ESOPHAGITIS IN PATIENTS WITH AIDS

Background: Although fluconazole is increasingly utilized for the therapy of Candida oesophagitis in patients with AIDS, the time course of response has not been adequately defined. Methods: Over a 48-mouth period, all HIV-infected patients undergoing upper endoscopy at a large city-county hospital were identified prospectively. Symptomatic patients with endoscopic and histopathologically confirmed Candida oesophagitis in whom oral antifungal therapy had not been received within the past three months were treated in an open-label fashion with fluconazole 200 mg on the first day followed by 100 mg daily for two weeks. All patients were followed clinically to determine the rapidity of response. Results: Eighteen patients were identified; all but two were male. Candida oesophagitis was graded as severe in 13 patients (72%). A complete symptomatic response was seen by five days in seven patients (39%) and by seven days in nine additional patients (cumulative response, 89%). The two other patients had improved by at least 50% at one week, with a complete symptomatic response seen at two weeks. Conclusions: Our study confirms anecdotal experience suggesting that fluconazole results in a rapid clinical response for Candida oesophagitis in patients with AIDS. Given this rapidity, a one-week course of empiric treatment with fluconazole for HIV-infected patients with newly developed esophageal symptoms could be used as an appropriate time period to assess a response prior to further diagnostic evaluation with endoscopy.