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How will oral thrush be treated if I have HIV or AIDS?

Posted by Be Well

How will oral thrush be treated if I have HIV or AIDS?
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If you have HIV or AIDS, you will have a lowered immune system. This means that your body is less able to fight off illnesses and infections. HIV attacks the infection-fighting cells in your immune system which, over time, weakens and becomes unable to defend your body against bacteria, viruses and germs.

Oral thrush is one type of a fungal infection called oral candida. If you have a lowered immune system, antifungal medicine is more effective for treating oral thrush than treatment applied to your skin (topical treatment).

If you've already been diagnosed with HIV or AIDS, you should be under the care of a specialist who will keep an eye on your immune status. Your specialist will also arrange any treatment you need, such as antiviral medicine to help your immune system. These specialists are usually based in HIV or STD clinics, although doctors are also involved in caring for people with HIV.

So, if you've been diagnosed with HIV or AIDS and have oral thrush, your doctor or specialist will prescribe an antifungal medicine for you. If you're under your doctor's care, in some cases, they may seek specialist advice before recommending treatment or they may refer you to a specialist.

What medicine will be prescribed?

The antifungal medicines used to treat oral thrush include fluconazole and itraconazole. (Brand names for fluconazole include Diflucan. Some medicines with this brand name are used to treat other forms of thrush, such as vaginal thrush in women or balanitis in men.)

If you have HIV, your doctor will usually prescribe fluconazole because it's less likely than itrconazole to cause side effects. It's also less likely to interact with other medicines that you may be taking. Your doctor will probably prescribe liquid medicine (suspension), although capsules are also available.

If you've become resistant to fluconazole, your doctor will seek specialist advice before prescribing itraconazole. Becoming resistant means that a medicine no longer works effectively, because the bacteria or viruses causing an infection have become immune to the medicine.

Your doctor or specialist will only prescribe other antifungal medicines if you've already shown serious resistance to fluconazole and itraconazole.

Your doctor or specialist may also consider whether you need antiviral medicines to help your immune system, as well as treating your oral thrush.

How do I take fluconazole?

You will need to take fluconazole for 7-14 days, depending on how you respond to the treatment. Your doctor will tell you what dose to take and for how long. After around seven days, your doctor will review how you're responding to the treatment.

You can take fluconazole as liquid medicine (suspension) or capsules. Liquid medicine is usually best because you can swirl it round your mouth before you swallow it. Remember:

  • If you wear dentures, take them out before you take your medicine.
  • Don't rinse your mouth out after you swallow your medicine.
  • Don't eat or drink for 30 minutes after taking your medicine.

If your kidneys aren't working properly (renal impairment), your doctor may need to adjust the dose of fluconazole that you take.

The most common side effects of fluconazole are:

Most people don't have any side effects.

Some medicines can interact with fluconazole which means that your treatment might be less effective. You should tell your doctor if you're taking:

  • warfarin,
  • medicines that control diabetes (sulphonylureas),
  • medicines that lower the response of your immune system (immunosuppressants), or
  • nevirapine.

Will I be referred to a specialist?

If you have HIV or AIDS and your infection has not cleared up when your treatment has finished, you need to see a doctor again. Your doctor may prescribe further treatment or refer you to a specialist.

Your doctor may also seek specialist advice or refer you to a specialist if you have HIV or AIDS and:

  • you're no longer seeing a specialist or have not been seeing one regularly,
  • you keep getting oral thrush or other oral candida infections,
  • your doctor knows you're resistant to fluconazole,
  • you're already taking another antifungal medicine to prevent infection - you may have become resistant to it, or
  • you're under 18.

Reinfection rates are high in people whose immune systems are severely lowered. Repeated infections affect 30-50% of people, usually returning within 14 days of stopping treatment.

Getting help

If you think you have oral thrush, you should see your doctor as soon as possible.

NOTICE: The information provided on this site is not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your physician or other qualified health provider because of something you have read on Wellsphere. If you have a medical emergency, call your doctor or 911 immediately.
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