The natural history of esophageal candidiasis after successful treatment in patients with AIDS.

BACKGROUND/AIMS: Antifungal therapy cures esophageal candidiasis in most patients with acquired immunodeficiency syndrome, but the subsequent course of these patients is not established. This study examines the natural history of esophageal candidiasis after successful treatment.

METHODS

Patients with endoscopic and clinical resolution of esophageal candidiasis after therapy were followed up prospectively with monthly clinical assessment and repeat endoscopy every 3 months or earlier if esophageal symptoms recurred or if the patient was to begin antifungal therapy for another reason.

RESULTS

Thirty-five patients met entry criteria; 21 agreed to enroll. The patients were followed up for a mean of 23 +/- 4 weeks after their initial posttreatment endoscopy. Nineteen patients (90%) had recurrent esophageal candidiasis at a mean of 11 +/- 2 weeks (range, 3-36 weeks). The 19 patients had 31 recurrences; 25 (81%) occurred < or = 10 weeks after documented cure of the prior episode of esophageal candidiasis. Twenty-two (71%) of the 31 recurrent episodes were symptomatic, and only 9 (29%) were associated with oral thrush. All symptomatic recurrences responded to treatment with fluconazole; 1 of 22 (5%) failed to show endoscopic resolution.

CONCLUSIONS

Almost all patients with acquired immunodeficiency syndrome and successfully treated esophageal candidiasis develop a recurrence, usually within 2-3 months. Two thirds are symptomatic and one third are associated with oral thrush. Subsequent episodes of esophageal candidiasis respond well to oral therapy.