Oral Candidiasis (Thrush)
Recurrent oral candidiasis in people living with HIV is common, especially as CD4+ cell counts decline. Thus, the most important method of prevention of oral candidiasis may be strengthening the immune system by stopping or slowing the course of HIV infection. Other preventative methods include use of anti-fungals, smoking cessation, good oral hygiene, avoidance of unnecessary antibiotics, alcohol, sugars and steroids. Topical therapy and gentian violent may also be useful as a preventive measure.
The benefits of preventive antifungal therapy are unclear. This is partly because of the risk it poses in the development of drug resistance, drug interactions and drug side effects. In general, long-term use of anti-fungals should be reserved for people with frequent or severe recurrences of candidiasis, particularly as the CD4+ cell count decline. People who experience occasional or infrequent recurrences of oral candidiasis (no more than three episodes per year) can be treated for each episode.
If recurrences are more frequent or severe, or if there is a history of esophageal candidiasis, preventative therapy with fluconazole may be recommended. According to the need, daily, three times weekly, or weekly fluconazole at a dose of 100-200mg is recommended. Again, the potential risk of developing azole resistance must be taken into account when considering long term use of systemic therapy for preventative purposes.
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