An updated guideline on the management of opportunistic candidiasis in people living with HIV has been issued by the British HIV Association (BHIVA). Oropharyngeal candidiasis remains the most common form of the infection. Despite a fall in prevalence since the availability of cART, its frequency has remained high compared with other opportunistic infections. It is associated with worsening immunodeficiency, the guideline notes. Key points include:
- Oral and oesophageal candidiasis are clinical diagnoses, with microbial confirmation and antifungal susceptibility testing only required when symptoms persist or recur during antifungal therapy.
- Fluconazole remains the preferred treatment for oropharyngeal candidiasis.
- Good oral hygiene is key to successful management.
- Topical therapy or oral fluconazole can be used to treat uncomplicated vulvovaginal candidiasis. This condition is treated in the same way as in the non-HIV population.
- Routine prophylaxis for mucosal candidiasis is not recommended: effective cART is the most successful strategy for managing the condition in patients with advanced HIV infection
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