In the early days of the epidemic, oral thrush was recognized as a defining emblem of HIV. The incidence of thrush has fallen dramatically with combo therapy, but it’s still the most common fungal infection in positive people. Now, a Wayne State University study has found that a new drug, Noxafil, has a cure rate of more than 90% and a relapse rate lower than that of other meds.
Caused by a yeastlike fungus (usually Candida albicans) that lives in healthy people, oral thrush can occur when the immune system weakens. Any HIV positive person can get it, but the risk rises as CD4s drop (especially below 300). The symptoms are white or red blotches on the tongue, gums and inner cheeks or painful cracks at the corners of the mouth. It can sneak down the throat and into the esophagus, making eating and swallowing excruciating.
Protease inhibitors (PIs) seem to block Candida: One study found that 7% of people taking PIs developed thrush, compared with 50% taking just nukes. Treatments include antifungals such as Mycelex (clotrimazole), Diflucan (fluconazole) and Sporanox (itraconazole), in the form of pills, lozenges or liquid to swish around in the mouth. (Natural therapies include cutting back on sugar and cigarettes and eating yogurt with active cultures of the friendly bacteria Lactobacillus acidophilus.)
Candida often returns once treatment with available drugs is stopped. That’s where Noxafil comes in. Jose Vazquez, MD, who led the Wayne State study that followed 350 people worldwide, says Noxafil matched Diflucan’s cure rate but did better at preventing return engagements. Submitted for approval in February, Noxafil could be available by early 2007.