The best initial treatment of human immunodeficiency virus (HIV) - infected patients with esophageal symptoms is unknown.
The outcome, including safety and cost-effectiveness, of fluconazole compared with endoscopy as a treatment strategy for HIV-infected patients with new-onset esophageal symptoms was evaluated.
During a 53-month period, 134 HIV-infected patients with esophageal symptoms were randomized prospectively to groups receiving either standard doses of fluconazole or endoscopy.
Among the 68 patients in the fluconazole group, a complete symptomatic response was observed in 56 patients (82%), usually within 1 week.
The most common endoscopic findings in the 66 patients in the endoscopy group included Candida esophagitis alone in 42 patients (64%) and ulcerative esophagitis in 10 patients (15%). Patients responding to empirical antifungal therapy or who had Candida esophagitis alone at endoscopy were less likely to have severe symptoms (P=0.027) or odynophagia as the only symptom (P<0.001) but more frequently had odynophagia and dysphagia (P=0.007) and thrush (P=0.002).
Empirical fluconazole was cost-effective, saving $738.16 per patient.
Empirical oral antifungal therapy with fluconazole is highly efficacious, safe, and cost-effective for HIV-infected patients with new-onset esophageal symptoms.
Mots-clés Pascal : SIDA, Virose, Infection, Virus immunodéficience humaine, Lentivirinae, Retroviridae, Virus, Complication, Symptomatologie, Oesophage, Stratégie, Traitement, Chimiothérapie, Antifongique, Fluconazole, Endoscopie, Etude comparative, Analyse avantage coût, Homme, Immunopathologie, Immunodéficit, Oesophage pathologie, Appareil digestif pathologie
Mots-clés Pascal anglais : AIDS, Viral disease, Infection, Human immunodeficiency virus, Lentivirinae, Retroviridae, Virus, Complication, Symptomatology, Esophagus, Strategy, Treatment, Chemotherapy, Antifungal agent, Endoscopy, Comparative study, Cost benefit analysis, Human, Immunopathology, Immune deficiency, Esophageal disease, Digestive diseases
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0308029
Code Inist : 002B06D01. Création : 10/04/1997.