American Board of Internal Medicine (ABIM) Certification Practice Exam

What systemic agent is used to treat esophageal candidiasis in HIV patients?

1. Ketoconazole

2. Fluconazole

3. Voriconazole

4. Terbinafine

The correct answer is: Fluconazole

Fluconazole is the systemic agent of choice for treating esophageal candidiasis in patients with HIV/AIDS. This condition arises due to immunocompromised states associated with HIV, leading to opportunistic infections like candidiasis. Fluconazole is particularly effective because it is well-absorbed orally, has excellent bioavailability, and penetrates well into the tissues, including the esophagus. It works by inhibiting the synthesis of ergosterol, a vital component of fungal cell membranes, which ultimately disrupts the integrity of the cell and leads to fungal cell death. Moreover, fluconazole is often preferred because it has a favorable side effect profile, and its dosing can be easily managed in outpatient settings. For patients with HIV, who may have recurrent or complicated infections, fluconazole also allows for a straightforward treatment regimen, making it the most practical choice for esophageal candidiasis. Other options listed, such as ketoconazole and voriconazole, while antifungal agents, are not first-line therapies for this specific indication. Ketoconazole is less commonly used due to better alternatives available, and voriconazole is more suited for aspergillosis and less effective against Candida species in this scenario. Terbinafine is