艾滋病与临床研究杂志

Background: Oral candidiasis is one of the most common opportunistic infections found in patients with Human Immunodeficiency Virus (HIV)/Acquired immune deficiency syndrome (AIDS). The number of HIV/AIDS patient increases every years. Past studies revelead the increment in the resistance of Candida species causing oral candidiasis against Fluconazole despite Fluconazole being the treatment of choice for this condition.

Objective: To evaluate the resistancy of Candida species to fluconazole in male patients with oral candidiasis and HIV/AIDS.

Methods: This was a descriptive observational study conducted in Dr. Soetomo General Hospital, Surabaya. The candida species was identified by using conventional methods. Resistancy against fluconazole were evaluated bydiskdiffusion method.

Results: There were 20 research subjects with 37 isolates of Candida species growing in culture. Candida species was found in 20 (54.1%) isolates, while 17 (45.9%) isolates showed non-albicans species. The resistance test of Candida species to fluconazole revealed that 18 (48.6%) isolates were resistant to fluconazole. Majority of the resistant isolates were of Candida non-albicans 13 isolates (72.2%).

Conclusion: The use of fluconazole drugs especially in patients with HIV/AIDS should be reevaluated as Candida species has developed high resistance towards the medication.

Objective: Tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) as HIV pre-exposure prophylaxis (PrEP) decreases bone mineral density (BMD). We explored the impact of vitamin D supplementation, dietary calcium intake, and bone loading exercise on BMD during the first 12 months of daily TDF/FTC PrEP.

Methods: All participants from the PREPARATORY-5 pilot demonstration project of gay and bisexual men were eligible for inclusion if they had dual-energy X-ray absorptiometry scans at both baseline and 12 months (n=39). Selfreported vitamin D supplementation was collected prospectively, whereas data on diet and exercise was obtained retrospectively after the trial period, using validated questionnaires. We compared median percent changes in BMD and trabecular bone score (TBS) between those with and without vitamin D supplementation, those with optimal (1000 mg/day) and inadequate (<500 mg/day) dietary calcium intake, and those in the highest versus lowest tertile of contemporaneous bone loading exercise.

Results: Median (interquartile range) participant age was 34 (29, 39) years, 74% were White, and most had some post-secondary education. Overall, median BMD declined significantly from baseline to 12 months at all anatomic sites, changing by -2.14% at the lumbar spine (p<0.01), -1.66% at the femoral neck (p<0.01), and -0.85% at the total hip (p<0.01). Compared to those not using vitamin D, those taking any vitamin D supplementation had a smaller median percent decline in the lumbar spine TBS that was not statistically significant (-1.42% versus -3.99%, p=0.06), and no difference in the lumbar spine BMD (-2.11% versus -2.14%, p=0.40), femoral neck BMD (-1.75% versus -1.17%, p=0.34) and total hip BMD (-0.89% versus - 0.69%, p=0.41). There were no significant differences in BMD or TBS according to dietary calcium intake or bone-loading exercise.

Conclusion: Vitamin D supplementation may have an attenuating effect on PrEP-related deterioration of lumbar spine bone microarchitecture. The relationship between vitamin D supplementation and PrEP-related changes in BMD warrants further investigation.