Abstract:
INTRODUCTION:
Oropharyngeal candidiasis (OPC) remains one of the most common opportunistic infections among HIV-infected adults. This study assessed the comparative efficacy and safety of different antifungals used for the prevention and management of OPC in adult patients with HIV.
METHODS:
A systematic literature review was conducted on the 4 major databases
(Medline, Embase, CENTRAL and Scopus) to identify randomized controlled trials (RCTs) that evaluated the efficacy of antifungal agents for their therapeutic or preventive effect compared to other antifungal agents or placebo, in HIV patients with OPC. Network meta-analysis was performed from the data extracted from the selected studies. For the therapeutic effect, the primary outcome was the clinical cure; the incidence of OPC was the primary outcome for preventive effect. The agents were ranked according to their efficacy as well as safety in the treatment as well as prevention of OPC using surface under the cumulative ranking (SUCRA).
RESULTS:
28 were included in the qualitative analysis and 22 for quantitative
analysis RCTs involving 3882 participants. In terms of clinical efficacy, fluconazole was ranked as the most effective antifungal agent in treating OPC (SUCRA=0.87) followed by posaconazole and itraconazole respectively. Gentian violet [RR, 0.61 (95%CI=0.40-0.94)] and nystatin [RR, 0.59 (95%CI=0.43-0.82)] were the least effective in achieving clinical cure when compared to fluconazole. Posaconazole was ranked the most efficacious agent in achieving mycological followed by fluconazole.
When compared to placebo, fluconazole was found to be effective in the prevention of OPC [RR, 0.45 (95%CI=0.27-0.77)]. While nystatin was ranked the safest, effect estimates of none of the other systemic antifungal agents were significantly higher than fluconazole.
CONCLUSION:
Based on the available evidence, fluconazole can be considered as the most effective drug in treatment as well as prevention of OPC among HIV-infected adults and has a favourable safety profile.
Keywords: oropharyngeal candidiasis, oral candidiasis, HIV; antifungal agents, prevention, treatment; systematic review, network meta-analysis
