Antifungal Use for Opportunistic Infection in HIV Patients: Comparison of Efficacy and Safety

Background: Fungal infections always occur in HIV patients due to depressed immunity. The most common fungal infections are candidiasis, cryptococcal meningitis and histoplasmosis. Objectives: To compare the efficacy and safety of the antifungal available for the three most common opportunistic fungal infections in HIV patients. Methods: The databases that we used to gather the information are PubMed, Lancet, Clin Infect Dis, SpringerLink, Ann Intern Med, J Clin Microbiol, Pediatr Infect Dis J and Int J Dermatol. Results: Based on our review, candidiasis can be sub-divided into localized (oropharyngeal and vulvovaginal) and systemic candidiasis. Fluconazole is found to be the most common used due to its high efficacy treating candidiasis. Prophylaxis of crytococcal meningitis can be done by administering ketoconazole or itraconazole depending on whether it is primary or secondary prophylaxis. Treatment using flucytosine in combination with amphotericin B has additive effect and appears to be the most effective regimen for cryptococcal meningitis therapy. Histoplasmosis is characterized by pulmonary and disseminated histoplasmosis and the mainstrays of therapy for histoplasmosis are amphotericin B and itraconazole. The most prominent side effects of amphotericin B include nephrotoxicity, acute toxicity and hypokalemia. Flucytosine and itraconazole induces gastrointestinal side effects and bone marrow depression while hepatotoxicity is found to be the major side effect of flucytosine and ketoconazole. Ultimate care must be taken when administering ketoconazole as it has considerable drug interactions with other medications. In patients treated with fluconazole, the most common adverse effects include phlebitis, headache and nausea, abdominal pain, diarrhoea and rashes. Conclusions: From our review, it appears to have different drug of choice of antifungals for different opportunistic fungal infections. Besides, it is found that different efficacy of different drugs form the basis guideline for the therapeutic regimen in treating opportunistic fungal infections. However, therapeutic regimens recommended also induce various types of adverse reactions or side effects. Therefore, dose adjustment and therapeutic drug monitoring must be performed accordingly and routinely to avoid unnecessary complications.