Interventions for prevention and treatment of vulvovaginal candidiasis in women with HIV infection.


BACKGROUND:Vulvovaginal candidiasis (VVC) is one of the most common fungal infections that recur frequently in HIV infected women. Symptoms of VVC are pruritis, discomfort, dyspareunia, and dysuria. Vulval infection presents as a morbiliform rash that may extend to the thighs. Vaginal infection is associated with white discharge, and plaques are seen on erythematous vaginal walls.Even though rarely or never resulting in systemic fungal infection or mortality, left untreated these lesions contribute considerably to the morbidity associated with HIV infection. Prevention and treatment of this condition is an essential part of maintaining the quality of life for these individuals. OBJECTIVES:-To compare the efficacy of various antifungals given vaginally or orally for the treatment and prophylaxis of VVC in HIV-infected women and to evaluate the risks of the same. SEARCH STRATEGY:The search strategy was comprehensive, iterative and based on that of the HIV/AIDS Cochrane Review Group. The aim was to locate all relevant trials, irrespective of publication status or language. Electronic databases :CENTRAL,Medline, EMBASE, LILACS and CINAHL were searched for randomised controlled trials for the years 1980 to 1st October 2010. WHO ICTRP site and other relevant web sites were also searched for conference abstracts. SELECTION CRITERIA:Randomised controlled trials (RCTs) of palliative, preventative or curative therapy were considered. Participants were HIV positive women receiving one or more of the following:treatment / prophylaxis for VVC or HAART(Highly Active Antiretroviral Therapy). DATA COLLECTION AND ANALYSIS:Three authors independently assessed the methodological quality of the trials and extracted data. The quality of the evidence generated was graded using the GRADE PRO approach. MAIN RESULTS:Our search did not yield any trial investigating treatment of VVC in HIV positive women.Two trials dealing with prophylaxis were eligible for inclusion.One trial (n= 323) favoured the use of weekly Fluconazole as compared to placebo (RR 0.68; 95% CI 0.47 to 0.97).The second trial with three arms of comparison;Clotrimazole,Lactobacillus and Placebo gave no definitive results in preventing an episode of VVC. Clotrimazole against placebo (RR 0.49; 95% CI 0.22 to 1.09), Clotrimazole against lactobacillus (RR 1.11; 95% CI 0.45 to 2.76) and lactobacillus against placebo (RR 0.54 ;95% CI 0.26 to 1.13). AUTHORS' CONCLUSIONS:Implications for practiceNo trials were found addressing treatment of VVC in HIV positive women.In comparison to placebo,Fluconazole was found to be an effective preventative intervention. However, the potential for resistant Candida organisms to develop might impact the feasibility of implementation.Direction of findings suggests that Clotrimazole and Lactobacillus improved the prophylactic outcomes when compared to placebo.Implications for research There is a need to evaluate drugs and drug regimens for VVC treatment and prophylaxis in HIV positive women through randomised clinical trials. Development of resistance to azoles remains under-studied and more work must be done in this area, so as to determine whether routine prophylaxis for VVC is at all needed or whether adequate ART would be sufficient to prevent recurrent VVC. The viral load in vaginal secretions with or without treatment or prophylaxis has not been studied, this is very relevant to the spread of HIV.


Ray A,Ray S,George AT,Swaminathan N




Has Abstract


2011-08-10 00:00:00








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    abstract:BACKGROUND:This is an update of a review that was first published in 2002. Female sterilisation is the most popular contraceptive method worldwide. Several techniques exist for interrupting the patency of fallopian tubes, including cutting and tying the tubes, damaging the tube using electric current, applying clips or...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Lawrie TA,Kulier R,Nardin JM

    更新日期:2015-09-07 00:00:00

  • Deferasirox for managing iron overload in people with myelodysplastic syndrome.

    abstract:BACKGROUND:The myelodysplastic syndrome (MDS) comprises a diverse group of haematopoietic stem cell disorders. Due to symptomatic anaemia, most people with MDS require supportive therapy including repeated red blood cell (RBC) transfusions. In combination with increased iron absorption, this contributes to the accumula...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Meerpohl JJ,Schell LK,Rücker G,Fleeman N,Motschall E,Niemeyer CM,Bassler D

    更新日期:2014-10-28 00:00:00

  • Single versus double intrauterine insemination (IUI) in stimulated cycles for subfertile couples.

    abstract:BACKGROUND:Intra uterine insemination (IUI), with or without controlled ovarian hyperstimulation (COH), is one of the treatment modalities offered to couples who have tried to conceive for at least one year (subfertile couples). It has been suggested that increasing the number of inseminations from one per cycle to two...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Cantineau AE,Heineman MJ,Cohlen BJ

    更新日期:2003-01-01 00:00:00

  • WITHDRAWN: Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults.

    abstract:BACKGROUND:Effective oral hygiene is a crucial factor in maintaining good oral health, which is associated with overall health and health-related quality of life. Dental floss has been used for many years in conjunction with toothbrushing for removing dental plaque in between teeth, however, interdental brushes have be...

    journal_title:The Cochrane database of systematic reviews

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    authors: Poklepovic Pericic T,Worthington HV,Johnson TM,Sambunjak D,Imai P,Clarkson JE,Tugwell P

    更新日期:2019-04-24 00:00:00

  • Early versus delayed antiretroviral treatment in HIV-positive people with cryptococcal meningitis.

    abstract:BACKGROUND:There remains uncertainty about the optimum timing of antiretroviral therapy (ART) initiation in HIV-positive people with cryptococcal meningitis. This uncertainty is the result of conflicting data on the mortality risk and occurrence of immune reconstitution inflammatory syndrome (IRIS) when ART is initiate...

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    authors: Eshun-Wilson I,Okwen MP,Richardson M,Bicanic T

    更新日期:2018-07-24 00:00:00

  • Glucocorticoids for croup in children.

    abstract:BACKGROUND:Glucocorticoids are commonly used for croup in children. This is an update of a Cochrane Review published in 1999 and previously updated in 2004 and 2011. OBJECTIVES:To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years. SEARCH METHODS:We searched the Cochrane ...

    journal_title:The Cochrane database of systematic reviews

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    authors: Gates A,Gates M,Vandermeer B,Johnson C,Hartling L,Johnson DW,Klassen TP

    更新日期:2018-08-22 00:00:00

  • Support surfaces for treating pressure ulcers.

    abstract:BACKGROUND:Pressure ulcers are treated by reducing pressure on the areas of damaged skin. Special support surfaces (including beds, mattresses and cushions) designed to redistribute pressure, are widely used as treatments. The relative effects of different support surfaces are unclear. OBJECTIVES:To assess the effects...

    journal_title:The Cochrane database of systematic reviews

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    authors: McInnes E,Dumville JC,Jammali-Blasi A,Bell-Syer SE

    更新日期:2011-12-07 00:00:00

  • Amantadine for fatigue in multiple sclerosis.

    abstract:BACKGROUND:Fatigue is one of the most common and disabling symptoms of people with Multiple Sclerosis (MS). The effective management of fatigue has an important impact on the patient's functioning, abilities, and quality of life. Although a number of strategies have been devised for reducing fatigue, treatment recommen...

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    authors: Pucci E,Branãs P,D'Amico R,Giuliani G,Solari A,Taus C

    更新日期:2007-01-24 00:00:00

  • Drugs for the treatment of nausea and vomiting in adults in the emergency department setting.

    abstract:BACKGROUND:Nausea and vomiting is a common and distressing presenting complaint in emergency departments (ED). The aetiology of nausea and vomiting in EDs is diverse and drugs are commonly prescribed. There is currently no consensus as to the optimum drug treatment of nausea and vomiting in the adult ED setting. OBJEC...

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    authors: Furyk JS,Meek RA,Egerton-Warburton D

    更新日期:2015-09-28 00:00:00

  • Interventions for cough in cancer.

    abstract:BACKGROUND:This is an updated version of the original Cochrane review first published in Issue 9, 2010 on "Interventions for cough in cancer". Cough is a common symptom in patients with malignancies, especially in patients with lung cancer. Cough is not well controlled in clinical practice and clinicians have few manag...

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    authors: Molassiotis A,Bailey C,Caress A,Tan JY

    更新日期:2015-05-19 00:00:00

  • Gamma-aminobutyric acid agonists for neuroleptic-induced tardive dyskinesia.

    abstract:BACKGROUND:Chronic antipsychotic drug treatment may cause tardive dyskinesia (TD), a long-term movement disorder. The gamma-aminobutyric acid (GABA) agonist drugs have been trialed as a treatment for TD, but these drugs have intense sedative properties and can possibly exacerbate psychotic symptoms. OBJECTIVES:To dete...

    journal_title:The Cochrane database of systematic reviews

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    authors: Soares KV,McGrath JJ,Deeks JJ

    更新日期:2000-01-01 00:00:00

  • Dornase alfa for cystic fibrosis.

    abstract:BACKGROUND:Dornase alfa is currently used as a mucolytic to treat pulmonary disease (the major cause of morbidity and mortality) in cystic fibrosis. It reduces mucus viscosity in the lungs, promoting improved clearance of secretions. This is an update of a previously published review. OBJECTIVES:To determine whether t...

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    authors: Yang C,Montgomery M

    更新日期:2018-09-06 00:00:00

  • Early surfactant administration with brief ventilation vs selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome.

    abstract:BACKGROUND:Both prophylactic and early surfactant replacement therapy, compared with later selective surfactant administration, reduce mortality and pulmonary complications in ventilated infants with respiratory distress syndrome (RDS). However, continued post-surfactant intubation and ventilation are risk factors for ...

    journal_title:The Cochrane database of systematic reviews

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    authors: Stevens TP,Blennow M,Soll RF

    更新日期:2004-01-01 00:00:00

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    abstract:BACKGROUND:General health checks are common elements of health care in some countries. They aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used individual screening tests offered in general health checks have been incompletely studied. Also,...

    journal_title:The Cochrane database of systematic reviews

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    authors: Krogsbøll LT,Jørgensen KJ,Gøtzsche PC

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  • Pharmacotherapies for sleep disturbances in Alzheimer's disease.

    abstract:BACKGROUND:Sleep disturbances, including reduced nocturnal sleep time, sleep fragmentation, nocturnal wandering and daytime sleepiness are common clinical problems in dementia due to Alzheimer's disease (AD), and are associated with significant caregiver distress, increased healthcare costs and institutionalisation. Dr...

    journal_title:The Cochrane database of systematic reviews

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    authors: McCleery J,Cohen DA,Sharpley AL

    更新日期:2014-03-21 00:00:00

  • Interventions to improve antibiotic prescribing practices for hospital inpatients.

    abstract:BACKGROUND:Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with i...

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    authors: Davey P,Marwick CA,Scott CL,Charani E,McNeil K,Brown E,Gould IM,Ramsay CR,Michie S

    更新日期:2017-02-09 00:00:00

  • Moderately early (7-14 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants.

    abstract:BACKGROUND:Corticosteroids have been used late in the neonatal period to treat chronic lung disease (CLD) in preterm babies, and early to try to prevent it. CLD is likely to be the result of persisting inflammation in the lung and the use of powerful anti-inflammatory drugs like dexamethasone has some rationale. Early ...

    journal_title:The Cochrane database of systematic reviews

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    authors: Halliday HL,Ehrenkranz RA,Doyle LW

    更新日期:2003-01-01 00:00:00

  • Push versus gravity for intermittent bolus gavage tube feeding of premature and low birth weight infants.

    abstract:BACKGROUND:Many small, sick and premature infants are unable to coordinate sucking, swallowing and breathing, and therefore, require gavage feeding. In gavage feeding, milk feeds are delivered through a tube passed via the nose or mouth into the stomach. Intermittent bolus milk feeds may be administered using a syringe...

    journal_title:The Cochrane database of systematic reviews

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    authors: Dawson JA,Summan R,Badawi N,Foster JP

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  • Proton pump inhibitors for chronic obstructive pulmonary disease.

    abstract:BACKGROUND:Chronic obstructive pulmonary disease (COPD) is a common and progressive disease characterised by chronic cough, airflow limitation and recurrent exacerbations. Since COPD exacerbations are linked to rising mortality and reduced quality of life, the condition poses a substantial burden on individuals, societ...

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  • Dental extractions prior to radiotherapy to the jaws for reducing post-radiotherapy dental complications.

    abstract:BACKGROUND:Radiotherapy as part of head and neck cancer treatment leaves patients requiring much dental rehabilitation in a compromised environment that is difficult for the patient and the dental team to manage. OBJECTIVES:To assess the effects of maintaining the patient's natural dentition during radiotherapy in com...

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    authors: Eliyas S,Al-Khayatt A,Porter RW,Briggs P

    更新日期:2013-02-28 00:00:00

  • Tocolytics for preterm premature rupture of membranes.

    abstract:BACKGROUND:In women with preterm labor, tocolysis has not been shown to improve perinatal mortality; however, it is often given for 48 hours to allow for the corticosteroid effect for fetal maturation. In women with preterm premature rupture of membranes (PPROM), the use of tocolysis is still controversial. In theory, ...

    journal_title:The Cochrane database of systematic reviews

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    authors: Mackeen AD,Seibel-Seamon J,Grimes-Dennis J,Baxter JK,Berghella V

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  • Short term urinary catheter policies following urogenital surgery in adults.

    abstract:BACKGROUND:Urinary catheterisation (by the urethral or suprapubic routes) is common following urogenital surgery. There is no consensus on how to minimize complications and practice varies. OBJECTIVES:To establish the optimal way to manage urinary catheters following urogenital surgery in adults. SEARCH STRATEGY:We s...

    journal_title:The Cochrane database of systematic reviews

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    authors: Phipps S,Lim YN,McClinton S,Barry C,Rane A,N'Dow J

    更新日期:2006-04-19 00:00:00

  • Tubal flushing for subfertility.

    abstract:BACKGROUND:A possible therapeutic effect of diagnostic tubal patency testing has been debated in the literature for half a century. Further debate surrounds whether oil-soluble or water-soluble contrast media might have the bigger fertility-enhancing effect. OBJECTIVES:To evaluate the effect of flushing a woman's fall...

    journal_title:The Cochrane database of systematic reviews

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    authors: Luttjeboer F,Harada T,Hughes E,Johnson N,Lilford R,Mol BW

    更新日期:2007-07-18 00:00:00

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    journal_title:The Cochrane database of systematic reviews

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    authors: Stead LF,Hughes JR

    更新日期:2012-02-15 00:00:00

  • Corticosteroids for myasthenia gravis.

    abstract:BACKGROUND:Although widely accepted as an appropriate immunosuppressive therapy, the efficacy of glucocorticosteroid treatment has only rarely been tested in controlled studies. OBJECTIVES:To assess the efficacy of glucocorticosteroids or adrenocorticotrophic hormone (ACTH) medication in autoimmune myasthenia gravis. ...

    journal_title:The Cochrane database of systematic reviews

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    authors: Schneider-Gold C,Gajdos P,Toyka KV,Hohlfeld RR

    更新日期:2005-04-18 00:00:00

  • Antibiotics for treating osteomyelitis in people with sickle cell disease.

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    journal_title:The Cochrane database of systematic reviews

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    authors: Martí-Carvajal AJ,Agreda-Pérez LH

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  • Position for women during second stage of labour.

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    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Gupta JK,Hofmeyr GJ

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  • Laparoscopic versus open liver resection for benign and malignant hepatic lesions in adults.

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    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Rao AM,Ahmed I

    更新日期:2013-05-31 00:00:00

  • Bisphosphonates for breast cancer.

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    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Pavlakis N,Schmidt R,Stockler M

    更新日期:2005-07-20 00:00:00

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    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Freites J,Stewart F,Omar MI,Mashayekhi A,Agur WI

    更新日期:2019-12-10 00:00:00