Azoles and AIDS

Patients with AIDS have compromised immune systems and are at greater risk for the development of opportunistic infections. Fungal infections that are common among AIDS patients include candidiasis (lesions in the skin or mouth), disseminated histoplasmosis (a form of pneumonia), and cryptococcal meningitis (inflammation of the membranes surrounding the brain and spinal cord). Fungal infections among patients with AIDS and the azole group of antifungal agents are reviewed. Cryptococcus neoformans (carried and transmitted by pigeon fecal matter) is the most common and life-threatening fungal infection in AIDS patients. Infection with Cryptococcus neoformans usually results in meningitis. The standard therapy for cryptococcal meningitis involves treatment with amphotericin B alone or in combination with flucytosine. Ketoconazole and miconazole do not readily penetrate into the cerebrospinal fluid (CSF) and thus are not very effective in treating meningitis. Recently, fluconazole was approved by the Food and Drug Administration (FDA) for the treatment of cryptococcal meningitis. In drug trial studies, fluconazole was effective in converting positive CSF cultures (cultures with cryptococcal meningitis) to negative cultures in 33 of 46 patients tested. In a larger drug study, fluconazole was found to be as effective as amphotericin B in converting positive CSF cultures to negative cultures. Itraconazole is a new drug, not yet approved by the FDA, that is currently undergoing preliminary trials for the treatment of cryptococcal meningitis. In AIDS patients with disseminated histoplasmosis, amphotericin B is one of the best available therapeutic agents; in one study, treatment with amphotericin B resulted in clinical improvement in 90 percent of patients. Ketoconazole and clotrimazole have been used successfully in the treatment of Candida infections in patients with AIDS. Preliminary studies with fluconazole indicate that it may also be useful in treating Candida infections. (Consumer Summary produced by Reliance Medical Information, Inc.)