Refractory mucosal candidiasis in advanced human immunodeficiency virus infection

Carl J. Fichtenbaum; Susan Koletar; Constantin Yiannoutsos; Fiona Holland; John Pottage; Susan E. Cohn; Ann Walawander; Peter Frame; Judith Feinberg; Michael Saag; Charles Van der Horst; W. G. Powderly

doi:10.1086/313765

Refractory mucosal candidiasis in advanced human immunodeficiency virus infection

Carl J. Fichtenbaum, Susan Koletar, Constantin Yiannoutsos, Fiona Holland, John Pottage, Susan E. Cohn, Ann Walawander, Peter Frame, Judith Feinberg, Michael Saag, Charles Van der Horst, W. G. Powderly

Medicine, Infectious Diseases Division

Research output: Contribution to journal › Article › peer-review

91 Scopus citations

Abstract

We conducted a multicenter, prospective study of the risk factors, natural history, and outcome of fluconazole-refractory mucosal candidiasis (FRMC) in 832 persons with advanced human immunodeficiency virus (HIV) infection (median CD4 cell count, 14/mm³) during 1994-1996. FRMC was defined as mucosal candidiasis that failed to resolve despite 14 days of therapy with daily doses (200 mg) of fluconazole. Thirty-six persons (4.3%) had FRMC (35, oral; 1, esophageal), for an incidence of 4.2 per 100 person-years (859.7 total years of follow-up). In a multivariate model, the use of trimethoprim-sulfamethoxazole within 6 months of enrollment (relative risk [RR], 2.39; P = .04) and the use of fluconazole daily or every other day (RR, 5.64; P = .004) were significantly associated with the development of FRMC. The median survival after the development of FRMC was 32.6 weeks. In conclusion, the annual incidence of FRMC was <5%. Refractory candidiasis was a poor prognostic indicator. Daily or every-other-day use of fluconazole was associated with the development of refractory infection.

Original language	English (US)
Pages (from-to)	749-756
Number of pages	8
Journal	Clinical Infectious Diseases
Volume	30
Issue number	5
DOIs	https://doi.org/10.1086/313765
State	Published - 2000

Funding

From the 1Washington University School of Medicine, St. Louis, Missouri; 2Harvard School of Public Health, Cambridge, Massachusetts; 3Rush Medical College, Chicago, Illinois; 4University of Rochester School of Medicine, New York, and 5Frontier Science Technology Research Foundation, Buffalo, New York; 6Ohio State University School of Medicine, Columbus, and 7University of Cincinnati College of Medicine, Ohio; 8University of Alabama–Birmingham School of Medicine; 9University of North Carolina School of Medicine, Chapel Hill Received 4 May 1999; revised 17 August 1999; electronically published 28 April 2000. Grant support: National Institutes of Health (AI-25903). The institutional review board at each participating site approved the study, and written informed consent was obtained from all patients. a Current affiliations: University of Cincinnati College of Medicine, Cincinnati, Ohio (C.F.); Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom (F.H.); Vertex Pharmaceuticals, 130 Waverly Street, Cambridge, Massachusetts (J.P.). b List of additional contributors appears at the end of text. Reprints or correspondence: Dr. Carl Fichtenbaum, University of Cincinnati Medical Center, Holmes Division, Infectious Diseases Center, Eden and Bethesda Avenues, Cincinnati, OH 45267-0405 (carl.fichtenbaum@uc .edu).

ASJC Scopus subject areas

Microbiology (medical)
Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1086/313765

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@article{e782c8d753be42d284fb68c535ce5f0b,

title = "Refractory mucosal candidiasis in advanced human immunodeficiency virus infection",

abstract = "We conducted a multicenter, prospective study of the risk factors, natural history, and outcome of fluconazole-refractory mucosal candidiasis (FRMC) in 832 persons with advanced human immunodeficiency virus (HIV) infection (median CD4 cell count, 14/mm3) during 1994-1996. FRMC was defined as mucosal candidiasis that failed to resolve despite 14 days of therapy with daily doses (200 mg) of fluconazole. Thirty-six persons (4.3%) had FRMC (35, oral; 1, esophageal), for an incidence of 4.2 per 100 person-years (859.7 total years of follow-up). In a multivariate model, the use of trimethoprim-sulfamethoxazole within 6 months of enrollment (relative risk [RR], 2.39; P = .04) and the use of fluconazole daily or every other day (RR, 5.64; P = .004) were significantly associated with the development of FRMC. The median survival after the development of FRMC was 32.6 weeks. In conclusion, the annual incidence of FRMC was <5%. Refractory candidiasis was a poor prognostic indicator. Daily or every-other-day use of fluconazole was associated with the development of refractory infection.",

author = "Fichtenbaum, {Carl J.} and Susan Koletar and Constantin Yiannoutsos and Fiona Holland and John Pottage and Cohn, {Susan E.} and Ann Walawander and Peter Frame and Judith Feinberg and Michael Saag and {Van der Horst}, Charles and Powderly, {W. G.}",

note = "Funding Information: From the 1Washington University School of Medicine, St. Louis, Missouri; 2Harvard School of Public Health, Cambridge, Massachusetts; 3Rush Medical College, Chicago, Illinois; 4University of Rochester School of Medicine, New York, and 5Frontier Science Technology Research Foundation, Buffalo, New York; 6Ohio State University School of Medicine, Columbus, and 7University of Cincinnati College of Medicine, Ohio; 8University of Alabama–Birmingham School of Medicine; 9University of North Carolina School of Medicine, Chapel Hill Funding Information: Received 4 May 1999; revised 17 August 1999; electronically published 28 April 2000. Grant support: National Institutes of Health (AI-25903). The institutional review board at each participating site approved the study, and written informed consent was obtained from all patients. a Current affiliations: University of Cincinnati College of Medicine, Cincinnati, Ohio (C.F.); Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom (F.H.); Vertex Pharmaceuticals, 130 Waverly Street, Cambridge, Massachusetts (J.P.). b List of additional contributors appears at the end of text. Reprints or correspondence: Dr. Carl Fichtenbaum, University of Cincinnati Medical Center, Holmes Division, Infectious Diseases Center, Eden and Bethesda Avenues, Cincinnati, OH 45267-0405 (carl.fichtenbaum@uc .edu).",

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doi = "10.1086/313765",

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T1 - Refractory mucosal candidiasis in advanced human immunodeficiency virus infection

AU - Fichtenbaum, Carl J.

AU - Koletar, Susan

AU - Yiannoutsos, Constantin

AU - Holland, Fiona

AU - Pottage, John

AU - Cohn, Susan E.

AU - Walawander, Ann

AU - Frame, Peter

AU - Feinberg, Judith

AU - Saag, Michael

AU - Van der Horst, Charles

AU - Powderly, W. G.

N1 - Funding Information: From the 1Washington University School of Medicine, St. Louis, Missouri; 2Harvard School of Public Health, Cambridge, Massachusetts; 3Rush Medical College, Chicago, Illinois; 4University of Rochester School of Medicine, New York, and 5Frontier Science Technology Research Foundation, Buffalo, New York; 6Ohio State University School of Medicine, Columbus, and 7University of Cincinnati College of Medicine, Ohio; 8University of Alabama–Birmingham School of Medicine; 9University of North Carolina School of Medicine, Chapel Hill Funding Information: Received 4 May 1999; revised 17 August 1999; electronically published 28 April 2000. Grant support: National Institutes of Health (AI-25903). The institutional review board at each participating site approved the study, and written informed consent was obtained from all patients. a Current affiliations: University of Cincinnati College of Medicine, Cincinnati, Ohio (C.F.); Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom (F.H.); Vertex Pharmaceuticals, 130 Waverly Street, Cambridge, Massachusetts (J.P.). b List of additional contributors appears at the end of text. Reprints or correspondence: Dr. Carl Fichtenbaum, University of Cincinnati Medical Center, Holmes Division, Infectious Diseases Center, Eden and Bethesda Avenues, Cincinnati, OH 45267-0405 (carl.fichtenbaum@uc .edu).

PY - 2000

Y1 - 2000

N2 - We conducted a multicenter, prospective study of the risk factors, natural history, and outcome of fluconazole-refractory mucosal candidiasis (FRMC) in 832 persons with advanced human immunodeficiency virus (HIV) infection (median CD4 cell count, 14/mm3) during 1994-1996. FRMC was defined as mucosal candidiasis that failed to resolve despite 14 days of therapy with daily doses (200 mg) of fluconazole. Thirty-six persons (4.3%) had FRMC (35, oral; 1, esophageal), for an incidence of 4.2 per 100 person-years (859.7 total years of follow-up). In a multivariate model, the use of trimethoprim-sulfamethoxazole within 6 months of enrollment (relative risk [RR], 2.39; P = .04) and the use of fluconazole daily or every other day (RR, 5.64; P = .004) were significantly associated with the development of FRMC. The median survival after the development of FRMC was 32.6 weeks. In conclusion, the annual incidence of FRMC was <5%. Refractory candidiasis was a poor prognostic indicator. Daily or every-other-day use of fluconazole was associated with the development of refractory infection.

AB - We conducted a multicenter, prospective study of the risk factors, natural history, and outcome of fluconazole-refractory mucosal candidiasis (FRMC) in 832 persons with advanced human immunodeficiency virus (HIV) infection (median CD4 cell count, 14/mm3) during 1994-1996. FRMC was defined as mucosal candidiasis that failed to resolve despite 14 days of therapy with daily doses (200 mg) of fluconazole. Thirty-six persons (4.3%) had FRMC (35, oral; 1, esophageal), for an incidence of 4.2 per 100 person-years (859.7 total years of follow-up). In a multivariate model, the use of trimethoprim-sulfamethoxazole within 6 months of enrollment (relative risk [RR], 2.39; P = .04) and the use of fluconazole daily or every other day (RR, 5.64; P = .004) were significantly associated with the development of FRMC. The median survival after the development of FRMC was 32.6 weeks. In conclusion, the annual incidence of FRMC was <5%. Refractory candidiasis was a poor prognostic indicator. Daily or every-other-day use of fluconazole was associated with the development of refractory infection.

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Refractory mucosal candidiasis in advanced human immunodeficiency virus infection

Abstract

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UN SDGs

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