By Anne Harding
October 05, 2016
NEW YORK (Reuters Health) – Gentian violet (GV) is as effective as nystatin for treating oral candidiasis (OC) in AIDS patients, at a fraction of the cost per treatment, according to new findings.
“It was as effective, it was well tolerated, and it was much less expensive,” Dr. Robert Salata of Case Western Reserve University in Cleveland, who worked on the new study, told Reuters Health in a telephone interview. The findings were published online September 24 in the journal AIDS.
OC is often the first presentation of HIV/AIDS, and can be very problematic and persistent in patients with more advanced disease, Dr. Salata said. While antiretroviral treatment has made OC less common among HIV-positive individuals in wealthier countries, it remains common in resource-limited areas, with prevalence as high as one-third of people with HIV, he and his colleagues write in their report.
GV, a dye that’s also used as an antiseptic, has been around for centuries, Dr. Salata noted, but its use has been limited because it causes bluish-purple staining that could be stigmatizing. Dr. Mahmoud Ghannoum, a co-author of the study and a Case Western colleague, tested more dilute concentrations in the lab and found they were strongly active against Candida.
To compare the two treatments head-to-head, Drs. Salata and Ghannoum and colleagues randomly assigned 221 patients at eight international centers to receive topical GV (5 mL of 0.00165% solution, swish and gargle and expectorate twice daily) or nystatin oral suspension (5mL of 100,000 units/mL swish and swallow four times daily) for 14 days.
Among patients eligible for analysis, 68.5% of the 92 in the GV group had cure or improvement of OC, compared to 67.8% of the 90 patients on nystatin, a non-significant difference.
There was also no difference between the two groups in cure rate. Both treatments were equally well tolerated and acceptable to patients, while adherence was also similar.
Sixty-one percent of the patients on GV reported no staining of the oral mucosa, while 28% reported mild staining, mainly on the tongue, and 11% had moderate staining. None of the patients stopped taking GV due to staining. Median cost per treatment course was $2.51 for GV and $19.42 for nystatin.
Based on the findings, Dr. Salata said, GV can be considered as an alternative to nystatin, in the United States as well as in resource-limited countries. Future research should compare GV to the costly “gold standard” OC treatment, fluconazole, he added, noting that fluconazole also carries a greater risk of causing drug-drug interactions than does GV.
