Overview of prevention of opportunistic infections in HIV-infected patients
- John G Bartlett, MD
John G Bartlett, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — HIV; Pulmonary Infections
- Professor Emeritus
- Johns Hopkins University School of Medicine
- Paul E Sax, MD
Paul E Sax, MD
- Clinical Director, Division of Infectious Diseases
- Brigham and Women's Hospital
- Professor of Medicine
- Harvard Medical School
Untreated HIV infection and HIV-related immunosuppression significantly increase the risk of acquiring opportunistic infections due to bacteria, viruses, fungi, and protozoa. These opportunistic infections were a major source of morbidity and mortality in HIV-infected patients prior to the development of effective antiretroviral therapy (ART) and still occur today, mostly in patients who are not receiving ART. Substantial advances in the prevention of opportunistic infections have been achieved. These strategies involve the use of antimicrobials, immunizations, and public health measures.
An overview of these different strategies will be reviewed here. The clinical manifestations, diagnosis, and treatment of specific opportunistic infections, as well as the use of secondary prophylaxis, are discussed elsewhere.
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- EPIDEMIOLOGY OF OPPORTUNISTIC INFECTIONS
- Impact of antimicrobial prevention
- Impact of antiretroviral therapy
- APPROACH TO INFECTION PREVENTION
- WHEN TO ADMINISTER ANTIMICROBIAL THERAPY
- All CD4 counts
- - Tuberculosis
- CD4 counts ≤250 cells/microL
- - Coccidioidomycosis
- CD4 counts ≤200 cells/microL
- - Pneumocystis
- CD4 counts ≤150 cells/microL
- - Histoplasmosis
- CD4 counts ≤100 cells/microL
- - Toxoplasma
- - Cryptococcus
- CD4 counts ≤50 cells/microl
- - Mycobacterium avium complex (MAC)
- EARLY DETECTION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS