ABSTRACT

Background: 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.

摘要

背景：口咽/食道念珠菌病是在人类免疫缺陷病毒 (HIV) 患者中观察到的最常见的机会性感染。虽然通常推荐的治疗方法是氟康唑，但近几十年来口咽或食道念珠菌病的复发率逐渐增加。

方法：目前的网络荟萃分析 (NMA) 包括随机对照试验 (RCT)，调查不同抗真菌干预措施对 HIV 感染者口咽或食道念珠菌病的疗效和可接受性（即退出率）。所有 NMA 程序均使用常客模型进行。

结果：纳入了 27 项 RCT 和 6277 名参与者。对于口咽念珠菌病，激光照射加亚甲蓝的基于光敏剂的抗菌光动力疗法 (aPDT) 与所研究干预措施中的最高治愈率和最低复发率相关[优势比 (OR) = 6.82, 95% 置信区间 (95 %CIs) = 0.19 至 244.42，p = 0.293，OR = 0.03，与氟康唑相比，95%CIs = 0.00 至 0.77，p = 0.034]。就治愈率/复发率而言，所研究的抗真菌干预措施均未优于氟康唑治疗食管念珠菌病。所有被调查的抗真菌干预措施都被广泛接受。

结论：aPDT 可能是治疗口咽念珠菌病的首选策略；然而，食管念珠菌病的证据仍然没有定论。