PERAWATAN KANDIDIASIS ORAL PADA PASIEN HIV/AIDS (Studi Pustaka)

Sri Rezeki; Febrina Rahmayanti

doi:10.24815/cdj.v13i1.20913

PERAWATAN KANDIDIASIS ORAL PADA PASIEN HIV/AIDS (Studi Pustaka)

Sri Rezeki, Febrina Rahmayanti

Abstract

Kandidiasis oral merupakan infeksi jamur oportunistik yang paling sering terjadi pada pasien HIV/AIDS. Terdapat beberapa obat antijamur yang dapat digunakan dalam perawatan kandidiasis oral pada pasien HIV/AIDS, namun pemilihannya tergantung beberapa faktor, seperti perluasan lesi, keparahan penyakit, kondisi asam lambung, level supresi imun, farmakodinamik/farmakokinetik, interaksi obat, resistensi, dan tingkat kepatuhan pasien. Namun, kandidiasis oral refractory dapat terjadi yaitu kegagalan dalam merespon perawatan dengan antijamur. Pada kasus seperti ini, identifikasi Candida dari daerah orofaring dapat membantu membedakan penyebab kegagalan lain secara mikrobiologis. Pasien AIDS diketahui mengalami hypochlorhydria dan peningkatan pH lambung, sehingga berpotensi terjadi penurunan absorpsi dan bioavailabilitas beberapa obat antijamur. Pasien dengan kondisi ini dapat diberikan flukonazol oral karena tidak tergantung pada pH lambung, dapat diabsorpsi dengan cepat, serta memiliki bioavailabilitas tinggi, sehingga flukonazol lebih unggul dibandingkan golongan azol lain dan antijamur topikal seperti nistatin supsensi oral maupun klotrimazol troches. Larutan itrakonazol dan posakonazol dapat dijadikan terapi second-line yang dapat digunakan, selain itu peningkatan imunitas lokal dan sistemik merupakan hal yang penting dalam melawan infeksi Candida. Dengan demikian, berdasarkan tinjauan pustaka flukonazol lebih baik digunakan dalam perawatan kandidiasis oral pada pasien HIV/AIDS.

Keywords

Perawatan; kandidiasis oral; antijamur; HIV/AIDS

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References

Regezi JA, Sciubba JJ, Jordan RC. Oral pathology clinical pathologic correlations. 4th ed. St. Louis: Saunders; 2017.p.104-8.

Ellepola ANB, Samaranayake LP. Oral candidal infection and antimycotics. Crit Rev Oral Biol Med. 2000;11(2):172-98. Available from: https://doi.org/10.1177/10454411000110020301

Tumbarello M, Caldarola G, Tacconelli E, Morace G, Posteraro B, Cauda R, et al. Analysis of the risk factors associated with the emergence of azole resistant oral candidosis in the course of HIV infection. JAC. 1996 Oct;38(4):691-9. Available from: https://doi.org/10.1093/jac/38.4.691

Sanglard D, Ischer F, Koymans L, Bille J. Amino acid substitution in the cytochrome P-450 lanosterol 14α-demethylase (CYP51A1) from azole-resistant Candida albicans clinical isolates contribute to resistance to azole antifungal agents. Antimicrob. Agents Chemother. 1998 Feb; 42(2):241-53.

Benson CA, Kaplan JE, Masur H, Pau A, Holmes KK. Treating opportunistic infections among HIV-infected adults and adolescents:recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. MMWR. 2004 Dec;53(RR15):1-112.

Chattopadhyay A, Gray LR, Patton LL, Caplan DJ, Slade GD, Tien HC, et al. Salivary secretory leukocyte protease inhibitor and oral candidiasis in human immunodeficiency virus type 1-infected persons. Infect Immun. 2004 Apr;72(4):1956-63. Available from: https://doi.org/10.1128/iai.72.4.1956-1963.2004

Frezzini C, Leao JC, Porter S. Current trends of HIV disease of the mouth. J Oral Pathol Med. 2005 Oct;34(9):513-31. Available from: https://doi.org/10.1111/j.1600-0714.2005.00337.x

Fichtenbaum CJ, Pappas PG. Candidiasis. In: Dolin R, Masur H, Saag M, editors. Aids therapy. 3th ed. Philadelphia: Churchill Livingstone; 2008. p. 801-13.

Pinjon E, Jackson CJ, Kelly SLS, Sanglard D, Moran G, Coleman DC, et al. Reduced azole susceptibility in genotype 3 Candida dubliniensis isolates associated with increased CdCDR1 and CdCDR2 expression. Antimicrob. Agents Chemother. 2005;45(4):1312-8. Available from: https://doi.org/10.1128/AAC.49.4.1312-1318.2005

Chattopadhyay A, Caplan DJ, Slade GD, Shugars DC, Tien HC, Patton LL. Insidence of oral candidiasis and oral hairy leukoplakia in HIV-infected adult in North Carolina. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Jan;99(1):39-47. Available from: https://doi.org/10.1016/j.tripleo.2004.06.081

Pelletier R, Peter J, Antin C, Gonzales CE, Wood L, Walsh TJ. Emergence of resistance of Candida albicans to clotrimazole in human immunodeficiency virus-infected children: In vitro and clinical correlation. J Clin Microbiol. 2000 Apr;38(4):1563-8. Available from: https://doi.org/10.1128/JCM.38.4.1563-1568.2000

Lattif AA, Banerjee U, Prasad R, Biswas A, Wig N, Sharma N, et al. Susceptibility pattern and molecular type of species-specific Candida in oropharyngeal lesions of indian human immunodeficiency virus-positive patients. J Clin Microbiol. 2004 Mar;42(3):1260-2. Available from: https://doi.org/10.1128/jcm.42.3.1260-1262.2004

Barchiesi F, Maracci M, Radi B, Arzeni D, Baldassarri I, Giacometti A, et al. Point prevalence, microbiology and fluconazole susceptibility patterns of yeast isolates colonizing the oral cavities of HIV-infected patients in the era of highly acive antiretroviral therapy. JAC. 2002 Dec;50(6):999-1002. Available from: https://doi.org/10.1093/jac/dkf233

Makarova NU, Pokrowsky VV, Kravchenko AV, Serebrovskaya LV, James MJ, Mc Neil MM, et al. Persistence of oropharyngeal Candida albicans strains with reduced susceptibilities to fluconazole among human immunodeficiency virus-seropositive children and adults in a long-term care facility. J Clin Microbiol. 2003;41(5):1833-7. Availablle from: https://doi.org/10.1128/JCM.41.5.1833-1837.2003

Farah CS, Ashman RB, Challacombe SJ. Oral candidosis. Clin Dermatol. 2000;18(5):553-62. Available from: https://doi.org/10.1016/s0738-081x(00)00145-0

Patton LL, Bonito AJ, Shugars DC, Hill C. A systematic review of the effectiveness of antifungal drugs for the prevention and treatment of oropharyngeal candidiasis in HIV-positive patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Aug;92(2):170-9. Available from: https://doi.org/10.1067/moe.2001.116600

Sherman RG, Prusinski L, Ravenel MC, Joralmin RA. Oral candidosis. Quintessence Int. 2002 Jul-Aug;33(7):521-32.

Patil S, Majumdar B, Sarode SC, Sarode GS, Awan KH. Oropharyngeal candidosis in HIV-infected patients - An update. Front Microbiol. 2018 May;9:980. Available from: https://doi.org/10.3389/fmicb.2018.00980

Martin MV. The use of fluconazole and itraconazole in the treatment of Candida albicans infections: A review. JAC. 1999 Oct;44(4):429-37. Available from: https://doi.org/10.1093/jac/44.4.429

Muzyka BC, Glick M. A review of oral fungal infections and appropriate therapy. JADA. 1995 Jan;126(1):63-72. Available from: https://doi.org/10.14219/jada.archive.1995.0025

Epstein JB, Gorsky M, Caldwell J. Fluconazole mouthrinses for oral candidiasis in postradiation, transplant, and other patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Jun;93(6):671-5. Available from: https://doi.org/10.1067/moe.2002.122728

Willis AM, Coulter WA, Fulton CR, Hayes JR. The influence of antifungal drugs on virulence properties of Candida albicans in patients with diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Mar;91(3):317-21. Available from: https://doi.org/10.1067/moe.2001.112155

Gage TW, Little JW. Mosby's 2007 dental drug consult. St.Louis: Mosby Co; 2007. p. 70, 290-1, 498, 662-3, 896.

Zunt SL. Oral candidiasis: diagnosis and treatment. J Pract Hyg. 2000;9:31-6.

Wynn RL, Meiller TF, Crossley HL. Drug information handbook for dentistry. 8th ed. Ohio: Lexi-Comp; 2002. p.92, 312, 508, 667-8, 673-4, 880.

Bennet JE. Antimicrobial agents antifungal agents. In: Brunton LL, Lazo JS, Parker KL, editors. Goodman & Gilman's The pharmacological basis of therapeutics. 11th ed. New York: McGraw-Hill; 2006. p. 1225-41.

Neville BW, Damm DD, Allen CM, Bouquot JE. Oral & maxillofacial pathology. 4th ed. Philadelphia: Saunders; 2016. p. 191-201.

Little JW, Falace DA, Miller CS, Rhodus NL. AIDS, HIV infection, and related conditions. In: Punjabi AP, editor. Dental management of the medically compromised patient. 8th ed. St.Louis: Mosby Co; 2013. p. 284-303.

Fleischmann CJ. Topical and systemic antifungal and antiviral agents. In: Newman MG, Winkelhoff AJV, editors. Antibiotic and antimicrobial use in dental practice .2nd ed. Chicago: Quintessence Publishing Co; 2001. p. 69-76.

Park NH, Kang MK. Antifungal and antiviral agents. In: Yagiela JA, Dowd FJ, Neidle EA, editors. Pharmacology and therapeutics for dentistry. 5th ed. New Delhi: Mosby Co; 2004. p. 660-6.

Walsh TJ, Gonzales CE, Piscitelli S, Bacher CD. Correlation between in vitro and in vivo antifungal activities in experimental fluconazole-resistant oropharyngeal and esophageal candidiasis. J Clin Microbiol. 2000 Jun;38(6):2369-73.

Akpan A, Morgan R. Oral candidiasis. Postgrad Med J. 2002 Aug;78(922):455-9. Available from: https://doi.org/10.1136/pmj.78.922.455

Lyons C, White TC. Transcriptional analyses of antifungal drug resistance in Candida albicans. Antimicrob Agents Chemother. 2000 Sept;44(9):2296-303. Available from: https://doi.org/10.1128/aac.44.9.2296-2303.2000

Martinez M, Lopez-Ribot JL, Kirkpatrick WR, Coco BJ, Bachmann SP, Petterson TF. Replacement of Candida albicans with C. dubliniensis in human immunodeficiency virus-infected patients with oropharyngeal candidiasis treated with fluconazole. J Clin Microbiol. 2002;40(9):3135-9. Available from: https://doi.org/10.1128/jcm.40.9.3135-3139.2002

Haberland-Carrodeguas C, Allen CM, Beck FM, Buesching WJ, Koletar SL, Sundstrom P. Prevalence of fluconazole-resistant strains of Candida albicans in otherwise healthy outpatients. J Oral Pathol Med. 2002 Feb;31(2):99-105. Available from: https://doi.org/10.1034/j.1600-0714.2002.310207.x

Rex JH, Pfaller MA, Walsh TJ, Chaturvedi V, Epinel-Ingroff A, Ghannoum MA, et al. Antifungal susceptibility testing: Practical aspects and current challenges. Clin Microbiol Rev. 2001 Oct;14(4):643-58. Available from: https://doi.org/10.1128/CMR.14.4.643-658.2001

Pappas PG, Rex JH, Sobel JD, Filler FG, Dismukes WE, Walsh TJ, Edwards JE. Guidelines for treatment of candidiasis. CID. 2004 Jan;38(2):161-89. Available from: https://doi.org/10.1086/380796

Ruhnke M, Schmidt-Westhausen A, Trautmann M. In vitro activities of variconazole (UK-109,496) against fluconazole-susceptible and-resistant Candida albicans isolates from oral cavities of patients with human immunodeficiency virus infection. Antimicrob. Agents Chemother. 1997 Mar;41(3):575-7. Available from: https://doi.org/10.1128/AAC.41.3.575

Gandolfo S, Scully C, Carrozzo M. Oral medicine. 3th ed. Philadelphia: Elsevier; 2006. p. 148.

Groll AH, Wood L, Roden M, Mickiene D, Chiou CC, Townley E, et al. Safety, pharmacokinetics, and pharmacodynamics of cyclodextrin itraconazole in pediatric patients with oropharyngeal candidiasis. Antimicrob. Agents Chemother. 2002 Aug;46(8):2554-63. Available from: https://doi.org/10.1128/aac.46.8.2554-2563.2002

Kartsonis NA, Saah A, Lipka CJ, Taylor A, Sable CA. Second-line therapy with caspofungin for mucosal or invasive candidiasis: result from the caspofungin compassionate-use study. JAC. 2004 May;53(5):878-81. Available from: https://doi.org/10.1093/jac/dkh179

Carrillo-Munoz A, Quindos G, Ruesga M, Alonso R. Antifungal activity of posaconazole compared with fluconazole and amphotericin B against yeast from oropharyngeal candidiasis and other infections. JAC. 2005 Mar;55(3):317-9. Available from: https://doi.org/10.1093/jac/dki022

Manfredi M, Polonelli L, Giovati L, Alnuami A, McCullough MJ. Oral and maxillofacial fungal infection. In: Farah CS, Balasubramaniam R, McCullough MJ, editors. Contemporary oral medicine a comprehensive approach to clinical practice. 1st ed. Switzerland: Springer; 2019. p. 967-973

Korting HC, Schaller M, Eder G. Hamm G, Bohmer U, Hube B. Effects of the human immunodeficiency virus (HIV) proteinase inhibitors saquinavir and indinavir on in vitro activities of secreted aspartyl proteinases of Candida albicans isolates from HIV infected patients. Antimicrob. Agents Chemother. 1999;43(8):2038-42. Available from: https://doi.org/10.1128/AAC.43.8.2038

Nittayananta W. Oral fungi in HIV: Challenges in antifungal therapies. Oral Diseases. 2016 Apr;22(suppl 1):107-13. Available from: https://doi.org/10.1111/odi.12394

DOI: https://doi.org/10.24815/cdj.v13i1.20913