Candidiasis is the most common fungal infection in people who have HIV. Candida is a yeast found in most people and is normally kept under control by “friendly” bacteria in your body. The most common fungus that causes candidiasis is called Candida albicans.
Symptoms and diagnosis
Doctors usually diagnose oral candidiasis or thrush, just by examining your mouth. Candidiasis can appear as white patches on your gums and the sides of your tongue, where it can cause a burning feeling, swelling, redness, and changes in the way things taste. Candidiasis can also appear in your esophagus (the tube that connects your mouth and stomach), where it can cause sore throat and difficulty swallowing.
Esophageal candidiasis may be diagnosed with a barium swallow and X-ray. Sometimes an endoscopy and biopsy are done. In women, symptoms of systemic candidiasis include itching and burning around the outside of the vagina, and a thick, white or yellow vaginal discharge. This is called a yeast infection.
Prevention
The risk of developing candidiasis increases if your T4 cell count falls below 400, although many people with much higher T4 counts show signs of candidiasis. Sugars can encourage the growth of candida. Some people go on sugar-free diets to decrease the risk of getting candidiasis. Others take a drug like fluconazole (Diflucan) or ketoconazole (Nizoral) to help prevent the infection. Rinsing your mouth with water and a few drops of hydrogen peroxide, tea tree oil, or grapefruit seed extract may be effective in preventing thrush.
Treatment
Mild thrush (candidiasis in your mouth) can sometimes be treated by rinsing your mouth several times a day with water and the substances described above. The bacterium called acidophilus, which is found in some brands of yogurt and also comes in pill form, may help reduce thrush. Sugar can make candidiasis worse, so you may want to eat less of it. An Aboriginal remedy called pitch uses the sap from certain trees as a mouthwash to treat thrush. Some people use a mouthwash made with apple cider vinegar and warm water.
Most come in pill form, but some are available as lozenges, mouth rinses, or vaginal suppositories. Amphotericin B can be taken intravenously (IV, or injected directly into a vein), as a lozenge, or as a specially prepared Mouth (taken by mouth) solution. Fluconazole and ketoconazole may cause nausea and headaches and, in rare cases, liver toxicity (poisoning).
The sinus medication called Seldane should be avoided if you’re taking ketoconazole or erythromycin. Nystatin in high doses can cause diarrhea or upset stomach. Since IV amphotericin B has many serious side effects, it’s often used only as a last resort.