Thursday, 21 July 2016


  • Complications
  • Candida are a group of common fungi that live on the skin and in the mouth. They are normally controlled by the immune system. However, if your immune system is weakened, Candida can grow on mucous membranes (the linings of body passages) or elsewhere in your body, causing symptoms known as candidiasis, candida or thrush.
    HIV-negative people may experience candidiasis when their immune systems are temporarily depressed by factors such as stress, smoking or alcohol, or medical conditions such as diabetes. Candidiasis may affect people taking antibiotics, because the antibiotic temporarily kills some of the harmless bacteria that inhabit the body, creating an imbalance that allows Candida to take their place. Using inhaled corticosteroids (to treat asthma and other conditions) can have the same effect. 
    Genital candidiasis may occur in the vagina in women, and under the foreskin in men, causing itching, burning or pain. Women are more at risk of candidiasis when they are pregnant. Candidiasis can be passed on from mother to baby during labour.
    Among people with HIV, mild candidiasis in the mouth is relatively common even with a relatively high CD4 cell count (below 500). It becomes more common with lower CD4 cell counts and recurrent infections can be a sign of HIV disease progression.


    On the gums, tongue, inner cheek and/or upper throat (oropharyngeal candidiasis), Candida grows in white clumps that can be scraped away, or causes red patches called erythema.
    Vaginal candidiasis can cause a discharge that can either be thick and yellowy-white, or clear and watery.


    It is easy to diagnose candidiasis in the mouth or oesophagus by inspecting the lesions. Doctors may take a tissue sample or swab to test for the fungus when other parts of the body are affected. They may also do blood tests to look for other conditions associated with candidiasis, if necessary.


    Candidiasis can be treated with anti-fungal drugs.
    There are several tablet-form (‘systemic’) drugs available such as itraconazole (Sporanox) and fluconazole (Diflucan). One drug, ketoconazole (Nizoral), is no longer recommended as it can cause liver toxicity. 
    Some anti-fungal drugs are also available in other forms, such as a liquid solution for oral candidiasis, creams for skin or nail infections, and creams and pessaries for vaginal candidiasis. You may also be offered anti-fungal lozenges containing anti-fungal drugs such as clotrimazole, nystatin (Nystan) or amphotericin, but generally the tablets seem to be the most effective. Systemic treatment will need to be used for more serious forms of candidiasis, such as oesophagal and pulmonary candidiasis. (You should not take oral anti-fungal treatment if you are pregnant.)
    Anti-fungal creams can damage latex condoms and make them less effective, so be careful of this if you are using these creams on your vagina or penis. 
    Anti-fungal drugs can cause side-effects such as nausea, vomiting and rashes. Itraconazole also interacts with a number of other drugs used by people with HIV, so your doctor or pharmacist should explain any potential interactions.
    Some Candida strains become resistant to fluconazole, especially among people with low CD4 counts or who have taken it for a long time or several times in quick succession.
    Some women find that bathing the genital area with diluted tea tree oil gel or live plain yoghurt can help relieve the symptoms of vaginal thrush.


    If you have had candidiasis before you started HIV treatment, you may well find that the problem disappears as your CD4 count rises and your immune system becomes better at fighting infections.
    If your candidiasis persists, anti-fungal drugs are effective at preventing candidiasis in people with low CD4 counts. There is a risk that prolonged exposure from using anti-fungal drugs as preventive therapy (prophylaxis) will encourage resistance. However, some people will need long-term therapy to prevent reoccurrence. There is a view that anti-fungal prophylaxis is not more likely to cause resistance than treating intermittent episodes, and that prophylaxis may also help to prevent more serious fungal infections such as cryptococcal meningitis. 
    Avoiding perfumed soaps, shower gels, vaginal deodorants or douches, tight-fitting underwear or tights can reduce the risk of developing vaginal candidiasis. Wearing cotton underwear and loose-fitting clothing can help.
    Good oral hygiene, and eating a healthy diet without too much sugar (including alcohol), can reduce the risk of oral thrush.
    Some complementary therapists recommend avoiding sweet food, white flour and starchy foods, with the idea that it will deprive the Candida organisms of food. This is an unproven option, but if you are considering trying this, it's a good idea to consult your doctor or a dietician to ensure that you are having a balanced diet. There have been some claims that eating ‘live’ yoghurt or probiotic supplements (that contain the ‘good bacteria’ Lactobacillus) can reduce levels of Candida in women with HIV, but this is not conclusive.


    Oesophageal candidiasis (in the gullet) is a more serious condition, and is classed as an AIDS-defining illness. This form of candidiasis can make it painful to eat. In people with low CD4 cell counts (usually under 100), Candida may grow in other parts of the body, such as the lungs (pulmonary candidiasis), and can become systemic, particularly in people who also have a low white blood cell count (neutropenia). Although rare, this can be very serious, even life-threatening

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