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Neftaly Opportunistic infection – Candidiasis section of the updated guidelines

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The updated guidelines for the prevention and treatment of opportunistic infections (OIs) in adults and adolescents with HIV, published by the National Institutes of Health (NIH) in September 2024, include several important updates regarding candidiasis management. Wiley Online Library+6ClinicalInfo+6Scribd+6

Key Updates on Candidiasis Management

1. Vulvovaginal Candidiasis (VVC)

• Ibrexafungerp: This antifungal agent has been added to the guidelines as a treatment option for vulvovaginal candidiasis and recurrent vulvovaginal candidiasis. It has received approval from the U.S. Food and Drug Administration (FDA).
• Oteseconazole: Another antifungal, oteseconazole, is now recognized for the treatment of recurrent vulvovaginal candidiasis and has also been approved by the FDA.ClinicalInfo

2. Oropharyngeal and Esophageal Candidiasis

• Suppressive Therapy: Secondary prophylaxis (chronic suppressive therapy) for recurrent oropharyngeal or vulvovaginal candidiasis is generally not recommended unless individuals experience frequent or severe recurrences.
• Treatment Options:
  • Oral Fluconazole: Used for suppressive therapy in cases of recurrent candidiasis.
  • Oral Posaconazole: Considered effective for esophageal candidiasis.
  • Alternative Therapies: For azole-refractory cases, echinocandins like anidulafungin, caspofungin, or micafungin are recommended.HIV Stage InformationHIV Stage Information+2National HIV Curriculum+2PMC+2

3. Duration of Suppressive Therapy

• While specific data on discontinuation are limited, it is generally reasonable to consider stopping secondary prophylaxis when the CD4 count has increased to >200 cells/mm³ following initiation of antiretroviral therapy (ART). HIV Stage Information

Additional Considerations

• Drug Resistance: The potential for the development of antifungal-resistant Candida strains should be considered when contemplating chronic maintenance therapy using azoles in people with HIV who are severely immunocompromised.
• Quality of Life: Factors such as the impact of recurrences on the individual’s well-being, the need for prophylaxis against other fungal infections, cost, adverse events, and drug–drug interactions should be considered when making the decision to use secondary prophylaxis.HIV Stage Information+1Wiley Online Library+1

For more detailed information, you can refer to the full guidelines available on the ClinicalInfo website. HIV Stage InformationClinicalInfo+1HIV Stage Information+1

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