Question 13 - Opportunistic Infections: Treatment Question Bank

HIV Clinical Care Question Bank

Opportunistic Infections: TreatmentQuestion 13/15

A 48-year-old woman with HIV and a CD4 count of 71 cells/mm³ recently started taking antiretroviral therapy, but after 3 weeks of treatment she develops altered taste sensation and odynophagia. She is seen in clinic and the physical examination shows oral candidiasis. She is diagnosed with oral candidiasis and probable esophageal candidiasis.

Which one of the following is the preferred therapy for the treatment of esophageal candidiasis?

Start micafungin by intravenous infusion and continue for a total of 10 to 14 days if there is a good clinical response

Start nystatin suspension swish and swallow, and continue for a total of 21 to 28 days if there is a good clinical response

Start oral fluconazole and continue for a total of 14 to 21 days if there is a good clinical response

Start oral voriconazole and continue for a total of 7 to 10 days if there is a good clinical response

Provide Question Feedback

Prev Skip

Sign In or Register Progress Not Saved!
Since you are not signed in, your progress won't be saved.

Question Last Updated
May 8th, 2026

Table 1. Treating Esophageal Candidiasis: Adult and Adolescent OI Guidelines

Treating Esophageal Candidiasis (Duration of Therapy 14 to 21 Days)

Note: Systemic antifungals are required for effective treatment of esophageal candidiasis (AI); topical therapy alone is not recommended (AI).

Preferred Therapy

Fluconazole 200-mg loading dose, followed by fluconazole 100–200 mg (up to 400 mg) PO or IV daily (AI); consider oral suspension for people with severe symptoms and difficulty swallowing.

Alternative Therapy

Itraconazole oral solution 200 mg PO daily (AI), or
Isavuconazole 400 mg PO as a loading dose, followed by isavuconazole 100 mg PO daily (BI), or
Isavuconazole 400 mg PO once weekly (BI), or
Voriconazole 200 mg PO or IV twice daily (BI), or
Posaconazole oral suspension 400 mg (10 mL) PO twice daily for 1 day, then 400 mg daily (BI), or
Posaconazole tablet 300 mg PO twice daily for 1 day, then 300 mg daily (BI), or
Lipid formulation of amphotericin B 3-4 mg/kg IV daily (BI), or
Caspofungin 70-mg loading dose IV, followed by 50 mg IV daily (BI), or
Micafungin 150 mg IV daily (BI), or
Anidulafungin 100 mg IV for one dose, then 50 mg IV daily (BI)

Note: A higher rate of esophageal candidiasis relapse has been reported with echinocandins than with fluconazole.

Other Considerations

Systemic azoles may have significant drug–drug interactions with antiretroviral drugs and other drugs used for the treatment of opportunistic infections. Consider therapeutic drug monitoring if prolonged use is indicated.
Fluconazole, itraconazole, posaconazole, and voriconazole can increase the risk for QTc prolongation, especially when coadministered with other QTc prolonging drugs that are cleared by CYP3A4.
Chronic or prolonged use of azoles might promote development of resistance.

Abbreviations: PO= orally; IV = intravenously; QTc = QT corrected for heart rate

Rating of strength of recommendation for the statement: A = Strong; B = Moderate; C = Weak
Quality of evidence for the recommendation: I = One or more randomized trials with clinical outcomes and/or validated laboratory endpoints; II = One or more well-designed, non-randomized trials or observational cohort studies with long-term clinical outcomes; III = Expert opinion

Source:

Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. National Institutes of Health, HIV Medicine Association, and Infectious Diseases Society of America. Candidiasis (Mucocutaneous). September 16, 2024. [HIV.gov]

Screening and Diagnosis

Basic HIV Primary Care

Antiretroviral Therapy

Co-Occurring Conditions

Prevention of HIV

Key Populations