General: Patients should tell their healthcare providers if they are taking any drugs (prescription or over-the-counter), herbs, or supplements. Patients should always take medications exactly as prescribed by their healthcare providers. HIV patients who have candidiasis infections usually receive treatment with antifungals. However, some antifungal medications may cause liver damage. Therefore, blood tests should be performed regularly during treatment to monitor liver function.
Oral thrush: Oral antifungals are typically used to treat oral thrush. The drug of choice is usually oral nystatin suspension (Mycostatin®), Nilstat®, or Nystex®). Other antifungals that may be used to treat oral thrush include amphotericin B (Fungizone®), fluconazole (Diflucan®), and ketoconazole (Nizoral®). Treatment generally lasts 10 to 14 days.
Ketoconazole and amphotericin B are the most likely to cause liver damage. Patients who experience nausea, vomiting, weakness, fatigue, abdominal pain (especially near the liver), dark urine, or jaundice (yellowing of the skin and eyes) should consult their healthcare providers.
Esophageal candidiasis: The most effective antifungal medication for esophageal candidiasis in HIV patients is the antifungal fluconazole (Diflucan®). This medication is taken orally, either as a tablet or liquid suspension. Other medications in the same family, including ketoconazole (Nizoral®) and itraconazole (Sporanox®), have also been used. Treatment duration varies from several days to several weeks or longer, depending on the severity of the infection.
Ketoconazole is the most likely to cause liver damage. Patients who experience nausea, vomiting, weakness, fatigue, abdominal pain (especially near the liver), dark urine, or jaundice (yellowing of the skin and eyes) should consult their healthcare providers.
Itraconazole may cause congestive heart failure. Patients who experience shortness of breath, coughing up white or pink phlegm, weakness, fatigue, fast heartbeat, sudden weight gain, or swelling of the feet, ankles, or legs should consult their healthcare providers.
Vulvovaginal candidiasis (yeast infection): Vaginal yeast infections have been treated with antifungal medications that are inserted directly into the vagina as suppositories, ingested as tablets, or applied to the skin as creams or ointments. Treatment generally lasts about one to seven days, depending on the severity of the symptoms. Common over-the-counter medications used include butoconazole (Femstat®), clotrimazole (Gyne-Lotrimin®), miconazole (Monistat 3®), tioconazole (Vagistat®, Trosyd®), and terconazole (Vagistat-1®). While these medications are available without a prescription, women who have never experienced a yeast infection before should consult their healthcare providers before self-medicating. This ensures that the symptoms are caused by Candida albicans and not sexually transmitted infections like ghonorrhea or chlamydia.
Unclear or conflicting scientific evidence:
Bitter orange: One controlled clinical trial found promising results using the oil of bitter orange as an antifungal agent. However, due to methodological weakness of the trial, further evidence is needed to confirm these results.
Avoid if allergic or hypersensitive to bitter orange or any members of the Rutaceae family. Avoid with heart disease, narrow-angel glaucoma, intestinal colic, and long QT interval syndrome. Avoid if taking anti-adrenergic agents, beta-blockers, QT-interval prolonging drugs, monoamine oxidase inhibitors (MAOIs), stimulants, or honey. Use cautiously with headache, hyperthyroidism (overactive thyroid), or if fair-skinned. Avoid if pregnant or breastfeeding.
Cranberry: Limited laboratory research has examined the antifungal activity of cranberry. There are no reliable human studies supporting the use of cranberry in this area.
Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium genus. Sweetened cranberry juice can affect blood sugar levels. Use cautiously with history of kidney stones. Pregnant and breastfeeding women should avoid cranberry in higher amounts than what is typically found in foods.
Pomegranate: The extract of pomegranate has been shown to be as effective as a commonly used oral gel when used topically to treat candidiasis associated with denture stomatitis (mouth sores) in a randomized controlled trial. Pomegranate extract in combination with Centella asiatica extract was found to have a statistically significant benefit in periodontal plaque reduction compared to placebo.
Avoid if allergic or hypersensitive to pomegranate. Avoid with diarrhea or high or low blood pressure. Avoid taking pomegranate fruit husk with oil or fats to treat parasites. Pomegranate root/stem bark should only be used under the supervision of a qualified healthcare professional. Use cautiously with liver damage or disease. Pomegranate supplementation may be unsafe during pregnancy if taken by mouth. The bark, root, and fruit rind may cause menstruation or uterine contractions. Avoid if breastfeeding due to a lack of scientific data.
Seaweed, kelp, bladderwrack: Laboratory study suggests antifungal and antibacterial activity of bladderwrack, which is a type of seaweed called kelp. However, there are no reliable human studies to support use as an antibacterial or antifungal agent.
Avoid if allergic or hypersensitive to Fucus vesiculosus and iodine. Avoid with history of thyroid disease, bleeding, acne, kidney disease, blood clots, nerve disorders, high blood pressure, stroke, or diabetes. Avoid if pregnant or breastfeeding.
Mucocutaneous candidiasis infections are less likely to develop in individuals who have healthy immune systems. Therefore, patients who have HIV/AIDS should receive highly active antiretroviral therapy (HAART), which suppresses HIV and subsequently boosts the body's immune system. Research has shown that HAART dramatically slows the progression of opportunistic infection in HIV/AIDS patients.
Decreasing or avoiding alcohol consumption may reduce the risk of developing mucocutaneous candidiasis. The body converts alcohol into sugar, which promotes the growth of Candida albicans.
Wear loose fitting clothes to help prevent vaginal candidiasis (yeast infections) because this provides better ventilation and allows areas of the body to dry out.
Maintain good oral hygiene by brushing the teeth daily, gargling with antiseptic mouthwash, and flossing the teeth.