Comparative Efficacy of Antifungal Agents Used in the Treatment of Oropharyngeal Candidiasis among HIV-Infected Adults: A Systematic Review and Network Meta-Analysis

Abstract

The objective of this study was to assess the comparative efficacy and safety of different antifungal agents used for the treatment of oropharyngeal candidiasis (OPC) in adult patients with HIV. A systematic search was performed on the four major databases (Medline, Embase, CENTRAL and Scopus) to identify randomized controlled trials (RCTs) that evaluated the efficacy of antifungal agents in HIV patients with OPC. A network meta-analysis was performed from the data extracted from the selected studies. The agents were ranked according using surface under the cumulative ranking (SUCRA). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of evidence. A total of 15 trials were included in the quantitative analysis involving the data from a total of 2883 participants. Fluconazole was ranked as the most effective antifungal agent to achieve clinical cure (SUCRA = 0.87) in OPC followed by posaconazole and itraconazole. Posaconazole was ranked the most efficacious agent in achieving mycological cure (SUCRA = 0.81), followed by fluconazole. While nystatin was ranked the safest, the effect estimates of none of the other systemic antifungal agents were significantly higher than fluconazole. Based on the available evidence, fluconazole can be considered as the most effective drug in the treatment of OPC among HIV-infected adults and has a favorable safety profile, followed by posaconazole.

In Silico and In Vitro Analysis of Sulforaphane Anti-Candida Activity

“…The most frequently used azole derivatives are itraconazole and fluconazole (FLZ) (both for oral administration) due to their low cost and toxicity [ 12 ]. FLZ is considered the most effective antifungal agent in OPC [ 13 ]. However, recent studies have reported isolates of resistant Candida species (for review, see: [ 14 ]) in immunocompromised patients [ 15 , 16 , 17 ], and associated this event with the increased use of azoles, especially FLZ, in prophylactic therapy [ 18 ], limiting therapy success [ 19 , 20 ].…”

Prevalence and antifungal susceptibility pattern of oral candidiasis among HIV-infected patients in a Mission Hospital, southeast Nigeria

“…In contrast, a research study in Cameroon (48) reported ketoconazole (85.5%) as the most active and nystatin (68.1%) as the least active of the ten antifungal drugs tested. In a systematic review and meta-analysis of comparative efficacy of antifungal agents used in the treatment of oral candidiasis among HIV-infected adults in 2021 (49), fluconazole was ranked the most effective antifungal against oral Candida.…”

Oral Candidiasis in Adult and Pediatric Patients with COVID-19

“…While the onset of OC in the course of HIV infection has historically rooted-although the changes in epidemiology and prognostic value related to the antiretroviral therapy (ART) era [ 15 , 16 , 17 , 18 ], the association between oral candidiasis and the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a recent finding that still is worthy of further study. The present paper aims to focus on this topic, reporting the incidence and prevalence of oral candidiasis COVID-19-associated and the possible etiopathogenic mechanisms underlying this association.…”