RTI International - News Release - 4.27.2001
RTI/UNC Study Reports that Antifungal Drug Can Prevent "Thrush" in People who are HIV Positive.
Rockville, MD - Use of the antifungal medication fluconazole can prevent the development of oral candidiasis, a common infection of the mouth also known as "thrush," in patients with HIV or AIDS, according to a summary released by the Agency for Healthcare Research and Quality (AHRQ).The summary is based on a report developed by the Evidence-based Practice Center (EPC) at the Research Triangle Institute and the University of North Carolina at Chapel Hill (www.rti.org/epc). The RTI/UNC report focused on several aspects of the dental management of persons in the United States infected with HIV or living with AIDS.
Dr. Arthur J. Bonito of RTI and Drs. Lauren Patton and Dan Shugars of UNC found that fluconazole was effective in reducing or preventing recurrences or new infections of thrush over a range of 3 to 17 months. While the evidence supports the effectiveness of several antifungal drugs to treat thrush once it is established, only fluconazole has been studied enough to be considered successful at preventing the infection.
The study also looked at two other issues:
- Complications of invasive oral procedures, and
- Use of oral conditions as markers or indicators of changes in health status.
The researchers found limited evidence about the risks of invasive oral procedures, concluding from four small studies that tooth extractions appear to result in few postoperative complications among persons living with HIV/AIDS. The complications that did occur were minor and treatable on an outpatient basis.
There was inadequate evidence to assess whether any of several oral conditions are usable as markers to indicate when a person converts from HIV negative to HIV positive. However, there is evidence that two oral conditions - thrush and Kaposi's sarcoma of the mouth - may be reasonable indicators that an HIV positive person has progressed to a state of severe immune suppression. The evidence discounts two other oral conditions - oral ulcers and hairy leukoplakia - as potential indicators of severe immune decline.
As with all Evidence Reports produced by the EPC for AHRQ, the findings are not to be considered as clinical guidelines. The paucity of evidence found on the clinical questions in particular and the fact that most of the studies reported predate the era of protease inhibitor use to treat AIDS point out the importance and need for additional research to address the questions.
The systematic review and analysis of the evidence for these critical oral health care issues was supported through a collaborative effort between AHRQ and the National Institute of Dental and Craniofacial Research of the National Institutes of Health.
The summary of Evidence Report/Technology Assessment Number 37, "Management of Dental Patients Who Are HIV Positive," is available online at www.ahrq.gov/clinic/denthivsum.htm. Printed copies are available from the AHRQ Publications Clearinghouse at ahrqpubs@ahrq.gov or by calling 1-800-358-9295. The summary also is available from the National Guideline Clearinghouse (NGC) at www.guideline.gov, click on NGC Resources. Copies of the full report are expected to be available from the Clearinghouse and on the NGC later in 2001.