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Evidence-Based Medicine

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Antifungal drug fluconazole found to be effective in preventing thrush in people who are HIV positive

Use of the antifungal medication fluconazole may help prevent the development of oral candidiasis, a common infection of the mucous membranes of the mouth also known as "thrush," in patients with HIV or AIDS, according to a report summary published recently by the Agency for Healthcare Research and Quality. The publication summarizes a report developed by AHRQ's Evidence-based Practice Center (EPC) at the Research Triangle Institute-University of North Carolina at Chapel Hill. The report focuses on several aspects of the dental management of people in the United States who have HIV infection or are living with AIDS.

The researchers found that fluconazole was effective in reducing or preventing recurrences or new infections of oral candidiasis over a range of 3 to 17 months. While the evidence appears to support the use of fluconazole, itraconazole, ketoconazole, nystatin, and clotrimazole for treating oral candidiasis once it is established, only fluconazole has been shown to be successful in preventing oral candidiasis.

The researchers also looked at two other aspects of dental management of people with HIV/AIDS: complications of invasive oral procedures and the use of oral conditions as markers or indicators of changes in health status. They found very limited evidence on the risks of invasive oral procedures. They concluded from four small studies that tooth extractions appear to result in few postoperative complications among people who are living with HIV/AIDS. The complications that did occur were minor and treatable on an outpatient basis.

There was inadequate evidence to assess whether any of several oral conditions are useful as markers to indicate when a person who has been exposed to HIV converts from HIV negative to HIV positive. However, there is evidence that two oral conditions—oral candidiasis and Kaposi's sarcoma of the mouth—may be reasonable indicators that an HIV-positive person has progressed to a state of severe immunosuppression. The evidence suggests that two other oral conditions—oral ulcers and hairy leukoplakia—are not reliable indicators of severe immune decline in people who are HIV positive.

The systematic review of the evidence for these critical oral health care issues was supported through a collaborative effort between AHRQ and the National Institute of Dental and Craniofacial Research of the National Institutes of Health.

A summary (AHRQ Publication No. 01-E041) of the report, Management of Dental Patients Who Are HIV Positive, Evidence Report/Technology Assessment 37, is available from the AHRQ Publications Clearinghouse.

Copies of the full report (AHRQ Publication No. 01-E042) will be available from AHRQ in late summer 2001.

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