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Fluconazole: Preventing Thrush in AIDS Patients Oral candidiasis, more commonly known as "thrush," is one of the most common oral complications in HIV positive and AIDS patients. Oral thrush can overwhelm a patient's compromised immune response and spread into the throat, causing esophageal thrush. More rarely, thrush can spread through the blood to the internal organs in late-stage AIDS patients leading to disseminated candidiasis. Contamination of the internal organs by the candida yeast can be fatal. The Agency for Healthcare Research and Quality (AHRQ) recently issued a report on the use of antifungal medications to prevent oral thrush in HIV positive patients. Prophylactic, or preventive, treatment would lower infection rates and reduce the likelihood of thrush spreading beyond the mouth. The report was based on the work of Dr. Arthur J. Bonito of North Carolina's Research Triangle Institute, and that of Dr. Lauren Patton and Dr. Dan Shugars of the University of North Carolina at Chapel Hill. They noted that, while several antifungal medications provided excellent thrush treatment for HIV patients, only one proved to be viable for preventive therapy. Fluconazole The medication—fluconazole—was found to reduce and prevent renewed outbreaks of thrush over the course of three to seventeen months. The medication had a significant response rate when compared to a placebo. The drug works by binding to a specific candida enzyme called p450. By binding to the enzyme, fluconazole prevents the production of ergosterol, which is a vital component in the yeast's cell wall production. Side effects of the medication include abdominal pain, gastrointestinal difficulties, allergic skin rashes and pain. Allergic reactions must be monitored carefully in HIV positive and AIDS patients. The study also found that the presence of oral thrush and Kaposi's sarcoma in the oral cavity could indicate that the HIV had progressed to the point of severe immunological suppression. The researchers warned that this information should not replace standard tests used to determine immune suppression. However, oral thrush could indicate the need for standard testing. Mating Candidiasis: A Breakthrough in Thrush Research In the 2000 issue of Science, researchers at the University of Minnesota revealed evidence that Candida albicans, a common cause of oral thrush, can reproduce sexually. Prior to this information, researchers believed that candida yeast cells reproduced asexually, but did not fully explain the yeast's ability to adapt to its environment and become resistant to medication. Researchers have long known that baker's yeast can reproduce sexually: two cells fuse to form a single cell. The new cell contains genetic code from both parents, making it possible for new strains of yeast to develop. The discovery that candida cells can also fuse to create new genetic sequences sheds light on how drug-resistant forms of the yeast can develop. Resources Agency for Healthcare Research and Quality. (2001). Management of dental patients who are HIV positive. Retrieved June 13, 2003, from www.ahrq.gov/clinic/epcsums/denthivsum.htm. HIVdent. (updated 2002). Fluconazole: A commonly used medication for HIV and AIDS patients. Retrieved June 14, 2003, from www.hivdent.org/drugs/FLUCONAZOLE.htm. New Zealand Dermatological Society. (updated 2002). Fluconazole. Retrieved June 14, 2003, from www.dermnetnz.org/index.html. Perdue, S. (2000). Identification of mating habits opens new doors to candida research. Retrieved June 14, 2003, from www.niaid.nih.gov/newsroom/releases/candida.htm. Research Triangle Institute. (2001). RTI/UNV study reports that antifungal drug can prevent "thrush" in people who are HIV positive. Retrieved June 13, 2003, from www.rti.org/page.cfm?objectid=4AA0BD5C-B4F1-446A- A7EEFE7C6C6F974D.

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