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

Research output: Contribution to journalArticlepeer-review

90 Scopus citations


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 languageEnglish (US)
Pages (from-to)749-756
Number of pages8
JournalClinical Infectious Diseases
Issue number5
StatePublished - 2000

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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