Overview Contents Learning resources Questions

Index 5.4 Gut infections 5.5 Candida and other skin problems 5.6 PCP

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Glossary Hide

AIDS acquired immune deficiency syndrome.

anti-fungal drug used to treat fungus infections.

ARV anti-retroviral (drug to treat HIV infection).

candida fungus (yeast) infection that affects the mouth and throat, gullet, sinuses, genital organs and – rarely – the brain

CD4 count number of CD4 cells in a drop of your blood. CD4 counts are measured in cells/mm³.

diagnosis identifying the cause of an illness.

fungus parasitic organism. Includes yeast. parasites that can cause stomach upset and severe diarrhoea.

HIV human immunodeficiency virus.

immune system different parts of your body used to fight infections.

opportunistic infection (OI) infection that occurs after your immune system has been damaged by HIV.

parasite an animal or plant that get nutrients and support from another species.

prophylaxis treatment to prevent an illness.

resistance when the genetic structure of an organism changes in ways that stops a drug from working.

symptom sign of illness.

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5 Opportunistic infections (OIs) and coinfections

5.5 Candida and other skin problems

Type of infection

Candida is a fungal yeast infection that frequently affects the mouth and throat (oral candida), gullet (oesophageal candida), sinuses, genital organs and – rarely – the brain.

Candida is also called thrush and it is very common in people with CD4 counts under 300 cells/mm³, and it becomes more common the lower the CD4 count.

Main symptoms

Oral thrush appears as white or red patches (especially in the mouth) that can sometimes be scraped off, and can include cracks at the corners of the mouth.
In the sinuses it can cause headaches, difficulty breathing and a build up of mucus.
In the gullet it can make eating difficult and result in vomiting.

Diagnosis

Visual examination for oral candida, swap sample for candida in other areas.

Treatment

Diet changes – cutting down on foods that contain refined sugars and wheat.
Live, unpasteurised yoghurt that contains lactobacillus bacteria can help – eaten or applied directly to the vagina.
Anti-fungal medications: co-trimoxazole lozenges, nystatin or itraconazole syrup, fluconazole oral solution, miconazole patch (for the inside of the mouth), ketaconazole, fluconazole and itraconazole tablets (fluconazole may be better if using rifampicin for TB treatment).

If CD4 counts increase in response to ARVs, candida should occur less often – and can stop completely.

Prophylaxis

Drugs are rarely used for prophylaxis in people who may get candida but with no symptoms because the risks of side effects and developing resistance usually outweigh the benefits of protection.

Research

There are several experimental treatments that may help people who develop resistance to existing anti-fungals.

Treatment training for advocates