Document 0358
 DOCN  M9590358
 TI    Problems with emerging azole resistance in the management of AIDS
       related fungal infections.
 DT    9509
 AU    Ellis D; Mycology Unit, Women's and Children's Hospital, North Adelaide.
 SO    Annu Conf Australas Soc HIV Med. 1994 Nov 3-6;6:135 (unnumbered
       abstract). Unique Identifier : AIDSLINE ASHM6/95291741
 AB    The emergence of AIDS has been responsible for a dramatic increase in
       human fungal infections, especially those caused by the yeast-like fungi
       Candida and Cryptococcus. These infections are essentially incurable and
       the basic aim of current treatment regimes is to eliminate or control
       the clinical symptoms for the duration of the patients life. However,
       the use of long term antifungal prophylaxis and/or maintenance therapy
       in adults infected with HIV has raised concerns about prevention,
       relapse and induced drug resistance. Drug resistant oral candidiasis
       caused by Candida krusei, C. glabrata, or C. albicans has been reported
       in late-stage AIDS patients [CD4 count < 50/mm3] on long term
       maintenance therapy with fluconazole. In vitro cross resistance with
       other azoles has also been reported, but to a lesser extent and
       itraconazole may be an effective alternative in patients that are
       non-responsive to fluconazole. Little data is currently available for
       itraconazole, however with greater utilisation it is likely that some
       resistance will also emerge. It is important to place reports of
       resistance into context with the large numbers of patients now being
       treated and to note that there may be several reasons for AIDS patients
       relapsing while on antifungal treatment, apart from drug resistance.
       Finally, the development of secondary resistance is poorly documented
       and pre- and post treatment isolates must be tested for both strain
       variation and MIC values by a reliable in vitro susceptibility test
       method.
 DE    Antifungal Agents/*THERAPEUTIC USE  Azoles/*THERAPEUTIC USE
       AIDS-Related Opportunistic Infections/*DRUG THERAPY  Candidiasis/*DRUG
       THERAPY  Cryptococcosis/*DRUG THERAPY  Drug Resistance, Multiple
       Fluconazole/THERAPEUTIC USE  Human  Itraconazole/THERAPEUTIC USE
       MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).