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- Title
Prise en charge médicamenteuse des principales mycoses opportunistes chez le patient infectés par le VIH.
- Authors
Houari, Meriem Bel; Zhim, Imane; Bouhlala, Nadia; Amezouar, Abdnbi; Ennefah, Waffae E; Lmsaouri, Jamal
- Abstract
Fungal infections in HIV-positive patients present a major challenge, despite advances in antiviral treatments. With an incidence of around 37%, these infections go beyond simple benign mycoses to include serious and potentially fatal forms. The management of these infections requires an individualised approach, taking into account the severity of the infection, drug sensitivity, co-morbidities and drug interactions, as these patients are often on a combination of antibacterial, antifungal and antiviral treatments. Candidiasis, particularly of the oropharynx, is the most common. Initial treatment involves local antifungal agents such as nystatin, followed by systemic treatments such as fluconazole in the event of resistance. Oesophageal candidiasis requires a broad-spectrum antifungal agent, principally fluconazole. Vaginal candidiasis is treated locally with imidazoles. Cryptococcosis, caused by Cryptococcus neoformans, is treated in three phases with a combination of amphotericin B, flucytosine and fluconazole, with close monitoring of the patient's response. Histoplasmosis, caused by Histoplasma capsulatum, can affect various organs. Initial treatment is with liposomal amphotericin B, followed by itraconazole if there is improvement, with particular attention to plasma levels due to variable absorption. Aspergillosis, although rare, has a high mortality rate. Voriconazole is the treatment of choice, requiring rigorous monitoring of plasma concentrations to avoid drug interactions. In summary, the management of fungal infections in HIV-positive patients requires a strategic approach, combining local and systemic treatments, with close monitoring to adjust therapies according to the patient's individual response.
- Subjects
HIV-positive persons; MEDICATION therapy management; FLUCONAZOLE; MYCOSES; HISTOPLASMA capsulatum
- Publication
Cahiers Santé - Médecine Thérapeutique, 2024, Vol 33, Issue 3, p147
- ISSN
2780-8858
- Publication type
Article
- DOI
10.1684/sanmt.2024.258