Drugs for Opportunistic Infections

About Diflucan® for the Diflucan Partnership Program (DPP)

Diflucan® (fluconazole) does not treat HIV/AIDS, but, as an antifungal medicine, it treats life-threatening fungal opportunistic infections. The program provides Diflucan® for the indications of Cryptococcal meningitis and Esophageal candidiasis.

Information about Diflucan® and Fungal Opportunistic Infections

Cryptococcal meningitis and other serious fungal infections are common complications in patients infected with human immunodeficiency virus (HIV). Diflucan® is one of WHO's recommended treatments for Cryptococcal meningitis and Esophageal candidiasis.

Cryptococcal Meningitis

• Cryptococcal meningitis is a life-threatening opportunistic infection of the brain caused by the yeast Cryptococcus neoformans. The infection invades the fluid surrounding the brain and spinal cord and causes damage to the central nervous system.
• Studies conducted in the United States suggest that between 6 and 10 percent of patients with AIDS, and in parts of Africa up to 30 percent, will develop cryptococcal meningitis. If left untreated, the prognosis is extremely poor. Relapse rates are as high as 50-60 percent, therefore, ongoing treatment is required for life [1].
• The onset of Cryptococcal meningitis is gradual and insidious, causing fatigue, fever, and weight loss followed by headache, nausea, vomiting, confusion, drowsiness, photophobia, and blurred vision [2].
• Definitive diagnosis of Cryptococcal meningitis can only be made by lumbar puncture (spinal tap), a medical procedure that must be performed in an appropriate medical facility.

Esophageal candidiasis

• Esophageal candidiasis is a fungal infection of the esophagus predominantly caused by Candida albicans [3]. In HIV-positive patients, this infection may be the first manifestation of AIDS [4].
• It is reported anecdotally in 20-40 percent of all patients with HIV/AIDS.
• The mortality rates are considerably lower for patients suffering Esophageal candidiasis than for those with Cryptococcal meningitis. However, Esophageal candidiasis frequently prevents patients from swallowing food and can lead to overall physical deterioration.
• Diagnosis of Esophageal candidiasis is made through clinical and microbiological assessment of the patient.
  

References
1.	Powderly, William et al. A controlled trial of fluconazole or amphotericin B to prevent relapse of Cryptococcal meningitis in patients with acquired immunodeficiency syndrome. New England Journal of Medicine 1992; 326: 793-798.
2.	Dismukes, William. Cryptococcal meningitis in patients with AIDS. The Journal of Infectious Diseases 1989; 157: 624-628.
3.	Vasquez, Jose. Therapeutic options for the management of Oropharyngeal and Esophageal candidiasis in HIV/AIDS patients. HIV Clinical Trials. 2000. 1:47-59.
4.	Ibid. 52.

DIFLUCAN® (FLUCONAZOLE)

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