Antifungals Used to Treat HIV-Related Infections

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Systemic fungal infections continue to be a major cause of illness and death in people with HIV, while superficial or uncomplicated infections are commonly noted. Among the opportunistic fungal infections most frequently associated with HIV:

  • Candidiasis
  • Cryptococcosis (including cryptococcal meningitis)
  • Histoplasmosis
  • Coccidioidomycosis (Valley Fever)

A number of other fungal infections (including aspergillosis, penicillosis, and blastomycosis) are also common in later-stage disease, most often in people with CD4 counts below 250.
There are a number of drugs commonly used to treat HIV-related fungal infections. The drugs are categorized by their specific mechanism of action and can be broken down into four general groups: polyene antifungals, azole antifungals, antimetabolite antifungals, and echinocandins.

Polyene Antifungals

Polyene antifungals work by breaking down the integrity of the fungal cell membrane, which eventually leads to cell death. The most common polyene antifungals used in HIV are:

Amphotericin B

Amphotericin B is commonly used for the treatment of systemic (whole-body) fungal infections such as cryptococcal meningitis. When delivered intravenously, amphotericin B is known to have serious side effects, often with an acute reaction occurring shortly after infusion (e.g., fever, chills, rigor, nausea, vomiting, headache, and muscle/joint pain). As such, the intravenous administration of amphotericin B is generally indicated in severely immune-compromised or critically ill patients. Oral preparations are available for use in treating candidiasis, which is safe for use with low drug toxicity.

Nystatin

Nystatin is delivered either orally or topically for superficial oral, esophageal, and vaginal candidiasis. Nystatin can also be used as a prophylactic (preventative) therapy in HIV-infected patients with high risk for fungal infection (CD4 count of 100 cells/mL or less). Nystatin is available as tablets, mouthwash, pastilles, powders, creams, and ointments.

Azole Antifungals

Azole antifungals interrupt the synthesis of enzymes needed to maintain the integrity of the fungal membrane, thereby inhibiting the fungus' ability to grow. Common side effects include rash, headache, dizziness, nausea, vomiting, diarrhea, side effects of diflucan during pregnancy, stomach cramps, and elevated liver enzymes.

Diflucan (Fluconazole)

Diflucan (fluconazole) is one of the most prescribed antifungals worldwide, Diflucan is used for the treatment of superficial and systemic fungal infections, including candidiasis, cryptococcosis, histoplasmosis, and coccidioidomycosis. Diflucan is available in tablet form, as a powder for oral suspension, or as a sterile solution for intravenous use.

Nizoral (Ketoconazole)

Nizoral (ketoconazole) was the very first oral azole no prescription diflucan canada pharmacy antifungal medication but has largely been supplanted by other azoles that have less toxicity and far greater absorption. It is available in tablet form, as well as in various topical applications for use on superficial fungal infections, including candidiasis.

Sporanox (Itraconazole)

Sporanox (itraconazole) is commonly used in systemic infection (such as candidiasis or cryptococcosis) when other antifungals are either ineffective or inappropriate. Sporanox is available in capsule form or as an oral solution (considered superior in terms of absorption and bioavailability). The intravenous preparation is no longer available in the U.S. Because of its low penetration into the cerebrospinal fluid, Sporanox is generally used only in second-line treatment when treating cryptococcal meningitis.

Other azoles being used in the treatment of opportunistic fungal infections are Vfend (voriconazole), and Posanol (posaconazole).

Treatment Options

If your athlete's foot fails to respond to over-the-counter medications, your healthcare provider will usually a prescribe prescription-strength how to buy diflucan canada no prescription version of the same topical medications. These include:

  • Lamisil (terbinafine)
  • Spectazole (econazole)
  • Mentax (butenafine)
  • Lotrimin (clotrimazole)
  • Micatin (miconazole)
  • Naftin (naftifine)
  • Luzu (luliconazole)
  • Ertaczo (sertaconazole)
  • Exelderm (sulconazole)
  • Tinactin (tolnaftate)

Treatment is usually continued for four weeks or at least one week after all of the skin symptoms have cleared.

If the fungus is resistant to topical treatment, oral antifungals—like Lamisil (terbinafine), Sporanox (itraconazole), and Diflucan (fluconazole)—may be prescribed. Oral antifungals may be prescribed for anywhere from effects of diflucan one to nine weeks depending on the severity of the infection.
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Randomized controlled trials of adults and children, who are HIV‐positive with low CD4 counts, without a current or prior diagnosis of cryptococcal disease that compared any antifungal drug taken as primary prophylaxis to placebo or online pharmacy diflucan standard care.

Data collection and analysis

Two review authors independently assessed eligibility and risk of bias, and extracted and analysed data. The primary outcome was all‐cause mortality. We summarized all outcomes using risk ratios (RR) with 95% confidence intervals (CI). Where appropriate, we pooled data in meta‐analyses. We assessed the certainty of the evidence using the GRADE approach.

Understanding the many connections between the guts and the mind will take time, and questions abound: Are there certain medication, exercise routines, or diets that profit or harm cognition?

Dr Cheryl L Barton

7 August, 2022