Effectiveness and Safety of Antifungal for Prevention of Oral and Esophageal Candidiasis in HIV Patients: A Systematic Review and Network Meta-analysis

Main Article Content

Nutcharin Rattanasaeng
Panumart Pumart
Nattawat Teerawattanapong
Ratree Sawangjit

Abstract

Objective: To determine the effectiveness and safety of antifungal drugs in the prevention of oral and esophageal candidiasis in HIV patients. Methods: Research studies were searched from electronic databases including PubMed, EMBASE, CENTRAL, Web of Science, Scopus, ProQuest, ClinicalTrials.gov, and Thai Library Integrated System (Thai LIS) up to December 31, 2022. This study included randomized controlled trials on the effectiveness and/or safety of all dosage regimens of antifungal drugs in the prevention of oral and esophageal candidiasis in HIV patients. The primary outcome was the prevention of primary oral and pharyngeal candidiasis and re-infection. The study combined results with frequentist framework-based network meta-analysis using random effect and estimated Surface Under the Cumulative Ranking (SUCRA) using Bayesian statistics to rank antifungal effectiveness and safety. Results: Fifteen studies involving 3,597 HIV patients aged 18 to 70 years were included. In all studies, patients had a mean CD4 count of less than 200 cells/mm3. Most of them studied the effect of oral antifungal drugs compared with placebo. The duration of drug treatment and follow-up ranged from 4 to 176 weeks. The results of the network meta- analysis showed that the administration of antifungal agents did not protect against primary candidiasis in both oral cavity and esophagus. However, daily and weekly use of fluconazole and daily doses of itraconazole prevented re-infection of oral candidiasis significantly better than placebo (RR=0.27, 95%Cl 0.16-0.44; RR=0.65, 95%Cl 0.47-0.90; RR =0.43, 95%Cl 0.25-0.75, respectively). These two dosage regimens of fluconazole also prevented 83% and 79% recurrent esophageal infections respectively compared to clotrimazole lozenge. The most common AEs were gastrointestinal symptoms and eczema. Conclusions: Antifungal drugs do not prevent primary oral and esophageal candidiasis in HIV patients. However, they are effective in preventing re-infection. The most effective drug for preventing re-infection of oral and esophageal candidiasis in AIDS patients was daily fluconazole.

Article Details

Section
Research Articles

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