Use of the antifungal medication fluconazole may help prevent the development of oral candidiasis, a common infection of the mucous membranes of the mouth also known as "thrush," in patients with HIV or AIDS, according to a report summary released today by the Agency for Healthcare Research and Quality (AHRQ). The publication summarizes a report, developed by AHRQ's Evidence-based Practice Center (EPC) at the Research Triangle Institute-University of North Carolina at Chapel Hill, that focused on several aspects of the dental management of persons in the United States infected with HIV or living with AIDS.
The researchers found that fluconazole was effective in reducing or preventing recurrences or new infections of oral candidiasis over a range of 3 to 17 months. While the evidence appears to support the use of fluconazole, itraconazole, ketoconazole, nystatin, and clotrimazole for treating oral candidiasis once it is established, only fluconazole has been shown to be successful at preventing oral candidiasis.
The study also looked at two other aspects of dental management of people with HIV/AIDS: Complications of invasive oral procedures, and the use of oral conditions as markers or indicators of changes in health status. The researchers found very limited evidence on 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-oral candidiasis 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 suggests that two other oral conditions-oral ulcers and hairy leukoplakia- are not reasonable indicators of severe immune decline in persons who are HIV positive.
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 the Evidence Report/Technology Assessment Number 37, Management of Dental Patients Who Are HIV Positive, is available online at http://www.ahrq.gov/clinic/denthivsum.htm. Printed copies are available from the AHRQ Publications Clearinghouse at email@example.com or by calling 1-800-358-9295. The summary also is available from the National Guideline Clearinghouse¿ (NGC) at http://www.guideline.gov/index.asp (click on NGC Resources).Copies of the full report are expected to be available from the Clearinghouse and on the NGC by summer, 2001.
For additional information, please contact AHRQ Public Affairs, (301) 594-1364: Jane Steele, (301) 594-6350 (JSteele@ahrq.gov); Karen Migdail, (301) 594-6120 (KMigdail@ahrq.gov).
Use of Antifungal Drug Fluconazole Effective in Preventing Thrush in Persons Who are HIV Positive. Press Release, April 24, 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/press/pr2001/thrushpr.htm