Patients with HIV infection who have a fungal infection other than cryptococcosis may require prophylaxis to prevent recurrent infection. While the risk for candidiasis has been affected by highly active antiretroviral therapy (HAART), deep fungal infections still require continued prophylaxis.


Documented disease is the indication for antifungal prophylaxis in patients with deep fungal infections (histoplasmosis, coccidioidomycosis).


Some investigators give primary antifungal prophylaxis for patients in endemic regions (Ohio and Mississippi River Valleys for Histoplasma, Southwest for Coccidioidomycosis) if the CD4 count is < 100 per µL.


There currently are no recommendations to discontinue antifungal prophylaxis for deep fungal infection once it has been started.


Prophylaxis is not usually recommended for mucosal candidiasis because of the effectiveness of current therapeutic agents and concerns about development of resistance.


Secondary prophylaxis may be indicated in a patient with:

(1) persistent candidiasis that is refractory to therapy

(2) esophageal candidiasis (especially if the CD4 count is < 100 per µL)


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