Efficacy and acceptability of different anti-fungal interventions in oropharyngeal or esophageal candidiasis in HIV co-infected adults: a pilot network meta-analysis. Issue 11 (2nd November 2021)

• Record Type: Journal Article
• Authors: Zeng, Bing-Syuan; Zeng, Bing-Yan; Hung, Chao-Ming; Chen, Tien-Yu; Wu, Yi-Cheng; Tu, Yu-Kang; Lin, Pao-Yen; Su, Kuan-Pin; Stubbs, Brendon; Sun, Cheuk-Kwan; Cheng, Yu-Shian; Li, Dian-Jeng; Liang, Chih-Sung; Hsu, Chih-Wei; Chen, Yen-Wen; Tseng, Ping-Tao; Chen, Chang-Hua
• Is Part Of: Expert review of anti-infective therapy. Volume 19:Issue 11(2021)
• Page Start: 1469
• Page End: 1479
• Publication Date: 2021-11-02
• Subjects: Candidiasis -- human immunodeficiency virus -- network meta-analysis -- antifungal -- opportunistic infection; Anti-infective agents -- Research -- Periodicals; 616.90461
• DOI: 10.1080/14787210.2021.1922078
• Languages: English
• ISSNs: 1478-7210

Abstract

ABSTRACT: Background : Oropharyngeal/esophageal candidiasis are the most common opportunistic infections observed in patients with human immunodeficiency virus (HIV). While the commonly recommended treatment is fluconazole, relapse of oropharyngeal or esophageal candidiasis has been gradually increasing in recent decades. Methods : The current network meta-analysis (NMA) included randomized controlled trials (RCTs) investigating the efficacy and acceptability (i.e. drop-out rate) of different anti-fungal interventions against oropharyngeal or esophageal candidiasis in adults with HIV. All NMA procedures were conducted using the frequentist model. Results : Twenty-seven RCTs and 6277 participants were included. For oropharyngeal candidiasis, photosensitizer-based antimicrobial photodynamic therapy (aPDT) with laser irradiation plus methylene blue was associated with the highest cure rate and the lowest relapse rate among the investigated interventions [odds ratio (OR) = 6.82, 95% confidence intervals (95%CIs) = 0.19 to 244.42, p = 0.293, and OR = 0.03, 95%CIs = 0.00 to 0.77, p = 0.034, compared to fluconazole]. None of the investigated anti-fungal interventions were superior to fluconazole for esophageal candidiasis in respect of cure rates/relapse rates. All investigated anti-fungal interventions were well-accepted. Conclusions : aPDT could be the preferred strategy to manage oropharyngeal candidiasis; however the evidence for esophageal candidiasis still remained inconclusive.