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Efficacy and acceptability of different anti-fungal interventions in oropharyngeal or esophageal candidiasis in HIV co-infected adults: a pilot network meta-analysis
journal contribution
posted on 2023-07-26, 15:24 authored by Bing-Syuan Zeng, Bing-Yan Zeng, Chao-Ming Hung, Tien-Yu Chen, Yi-Cheng Wu, Yu-Kang Tu, Pao-Yen Lin, Kuan-Pin Su, Brendon Stubbs, Cheuk-Kwan Sun, Yu-Shian Cheng, Dian-Jeng Li, Chih-Sung Liang, Chih-Wei Hsu, Yen-Wen Chen, Ping-Tao Tseng, Chang-Hua ChenBackground: 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.
History
Refereed
- Yes
Volume
19Issue number
11Page range
1469-1479Publication title
Expert Review of Anti-infective TherapyISSN
1744-8336External DOI
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Taylor & FrancisLanguage
- other
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2021-06-02Legacy Faculty/School/Department
Faculty of Health, Education, Medicine & Social CareUsage metrics
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