Document 0624
 DOCN  M9460624
 TI    Treatment of systemic mycoses in patients with AIDS.
 DT    9404
 AU    Graybill JR; Infectious Diseases Section, Audie Murphy VA Hospital, San;
       Antonio, Texas 78284.
 SO    Arch Med Res. 1993 Winter;24(4):403-12. Unique Identifier : AIDSLINE
       MED/94162846
 AB    Far and away the most common fungal infection associated with HIV
       infection is candidiasis. This tends to produce mucosal topical
       infections and local treatment may be enough to control them. Generally
       we prefer courses of 1-2 weeks rather than chronic suppression, for fear
       of eliciting overgrowth of resistant isolates. Fluconazole resistant
       Candida species may be an increasing problem over the next decade. For
       cryptococcoses the problem is both simpler and more complicated.
       Fluconazole is highly effective for chronic suppression, but not very
       effective for initial therapy. Here a short course of amphotericin B,
       just 2 weeks in length, is followed by chronic azole suppression.
       Fluconazole appears excellent, but itraconazole may also be effective.
       For histoplasmosis itraconazole appears to be the most advantageous
       drug, with excellent clinical response within 2 weeks. A role for
       fluconazole is unclear. Coccidioidomycosis is uncommon, but difficult. I
       cannot offer any suggestions on ideal therapy here. Other diseases, such
       as aspergillosis, are extremely uncommon but still are AIDS associated
       mycoses. It is my personal fear that as we go along identifying the AIDS
       virus and its complications, aspergillosis and zygomycosis may establish
       themselves as the future black hats for which we will need to pull
       something out of the box. What to pull is not very clear.
 DE    Antifungal Agents/*THERAPEUTIC USE  Azoles/THERAPEUTIC USE  AIDS-Related
       Opportunistic Infections/*DRUG THERAPY  Flucytosine/THERAPEUTIC USE
       Human  Mycoses/COMPLICATIONS/*DRUG THERAPY  Polyenes/THERAPEUTIC USE
       JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

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