{"id":209,"date":"2023-01-01T12:00:09","date_gmt":"2023-01-01T12:00:09","guid":{"rendered":"http:\/\/moomango.co.uk\/ttfa\/5-opportunistic-infections-ois-and-coinfections\/5-5-candida-and-other-skin-problems"},"modified":"2023-02-03T12:29:32","modified_gmt":"2023-02-03T12:29:32","slug":"5-candida-and-other-skin-problems","status":"publish","type":"page","link":"https:\/\/i-base.info\/ttfa\/5-ois-and-coinfections\/5-candida-and-other-skin-problems\/","title":{"rendered":"5. 5 Candida (thrush) and skin problems"},"content":{"rendered":"<h2 id=\"type\">Type of infection<\/h2>\n<p><strong>Candida is a fungal yeast infection that is also called thrush.<\/strong><\/p>\n<p><strong>It can affect the mouth (oral thrush), throat (oesophageal thrush), sinuses, bowels and genitals. In rare cases it can affect the brain.<\/strong><\/p>\n<p>Thrush is common when the CD4 count is under 200. It also becomes more common if the CD4 count drops lower. Genital thrush can occur at any CD4 count and is not linked to HIV.<\/p>\n<h2 id=\"main\">Main symptoms<\/h2>\n<ul>\n<li>Oral thrush usually appears as white patches, especially in the mouth. These can sometimes be scraped off. Thrush can also cause cracks at the corners of the mouth.<\/li>\n<li>In the sinuses, thrush\u00a0can cause headaches and difficulty breathing. It can increase the amount of mucus.<\/li>\n<li>In the throat thrush can make eating and swallowing painful and difficult. This can make it difficult to hold down food.<\/li>\n<\/ul>\n<h2 id=\"diagnosis\">Diagnosis<\/h2>\n<p>Thrush is often just diagnosed by sight, Swab samples are sometimes tested for other areas.<\/p>\n<h2 id=\"treat\">Treatment<\/h2>\n<ul>\n<li>Diet changes can help. For example, cutting down on refined sugars and wheat.<\/li>\n<li>Eating live, unpasteurised yoghurt that contains <strong>lactobacillus<\/strong> bacteria might help oral or vaginal thrush. Some people use yogurt topically, although this is not generally recommended.<\/li>\n<li>First-line treatment includes\u00a0<strong>fluconazole tablets, oral solution or topical cream<\/strong>.<br \/>\nOther options can include\u00a0<strong>co-trimoxazole<\/strong> lozenges, <strong>nystatin<\/strong> or <strong>itraconazole<\/strong> syrup. <strong>Miconazole<\/strong> patches can be used in the mouth.\u00a0<strong>Ketaconazole<\/strong>\u00a0and <strong>itraconazole<\/strong> tablets (or fluconazole if using rifampicin for TB).<\/li>\n<li><strong>Caspofungin, micafungin <\/strong>and<strong> anidulafungin<\/strong> are first-line treatment, for invasive (internal) thrush. These are given by infusion.<\/li>\n<li><strong>Ibrexafungerp<\/strong> can be active against drug resistant thrush.<\/li>\n<\/ul>\n<p>If the CD4 count increases on ART, thrush should occur less often or stop completely.<\/p>\n<h2 id=\"prevent\">Prophylaxis<\/h2>\n<p>Drugs are rarely used unless someone has symptoms. This is because of the risks of side effects and drug resistance. It is easier just to treat when needed.<\/p>\n<h2 id=\"research\">Research<\/h2>\n<p>Ongoing research is looking at ways to treat drug resistant thrush. Most of this research is not directly related to HIV.<\/p>\n<h2 id=\"other\">Other skin problems<\/h2>\n<p>Minor skin problems can be an early symptoms of a low CD4 count.<\/p>\n<p>Often these are relatively minor, like dry skin. They can also be from infections that your immune system can no longer fight.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.bhiva.org\/OI-guidelines-candidiasis\">BHIVA guidelines on the management of opportunistic infection in people living with HIV:\u00a0The clinical management of candidiasis 2019 (2022 interim update)<img decoding=\"async\" title=\"NICE accredited\" src=\"https:\/\/www.bhiva.org\/image\/mZOACunIVEorT\" alt=\"NICE accredited\" border=\"0\" \/><\/a><\/li>\n<li><a href=\"https:\/\/www.bhiva.org\/file\/60795d8e8af4c\/BHIVA-candidiasis-OI-guidelines-non-technical.pdf\" target=\"_blank\" rel=\"noopener\">View non-technical summary<\/a><\/li>\n<li><a href=\"https:\/\/bnf.nice.org.uk\/treatment-summaries\/antifungals-systemic-use\/\" rel=\"noopener\">BNF page on systemic antifungal drugs.<\/a><\/li>\n<li><a href=\"\/\/clinicalinfo.hiv.gov\/en\/guidelines\/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections\/candidiasis-0?view=full\" rel=\"noopener\">US CDC guidelines for HIV-related candida<\/a> (from the US guidelines on Opportunistic Infections).<\/li>\n<li><a href=\"https:\/\/www.cdc.gov\/std\/treatment-guidelines\/candidiasis.htm\" rel=\"noopener\">US CDC guidelines for vaginal thrush<\/a> (not HIV-specific)<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Type of infection Candida is a fungal yeast infection that is also called thrush. It can affect the mouth (oral thrush), throat (oesophageal thrush), sinuses, bowels and genitals. In rare cases it can affect the brain. Thrush is common when &hellip;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":199,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-209","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/pages\/209","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/comments?post=209"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/pages\/209\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/pages\/199"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/media?parent=209"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}