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Overview of prevention of opportunistic infections in HIV-infected patients

John G Bartlett, MD
Paul E Sax, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH


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 (OIs) 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. Strategies for the prevention of OIs 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.

(See "Treatment and prevention of Pneumocystis infection in HIV-infected patients".)

(See "Toxoplasmosis in HIV-infected patients".)

(See "Mycobacterium avium complex (MAC) infections in HIV-infected patients".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 11, 2017.
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  1. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguideline s/adult_oi.pdf (Accessed on June 23, 2017).
  2. Nightingale SD, Byrd LT, Southern PM, et al. Incidence of Mycobacterium avium-intracellulare complex bacteremia in human immunodeficiency virus-positive patients. J Infect Dis 1992; 165:1082.
  3. Saah AJ, Hoover DR, Peng Y, et al. Predictors for failure of Pneumocystis carinii pneumonia prophylaxis. Multicenter AIDS Cohort Study. JAMA 1995; 273:1197.
  4. Heffelfinger JD, Voetsch AC, Nakamura GV, et al. Nonadherence to primary prophylaxis against Pneumocystis jirovecii pneumonia. PLoS One 2009; 4:e5002.
  5. Teshale EH, Hanson DL, Wolfe MI, et al. Reasons for lack of appropriate receipt of primary Pneumocystis jiroveci pneumonia prophylaxis among HIV-infected persons receiving treatment in the United States: 1994-2003. Clin Infect Dis 2007; 44:879.
  6. Gallant JE, Moore RD, Chaisson RE. Prophylaxis for opportunistic infections in patients with HIV infection. Ann Intern Med 1994; 120:932.
  7. Ledergerber B, Egger M, Erard V, et al. AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy: the Swiss HIV Cohort Study. JAMA 1999; 282:2220.
  8. Brooks JT, Kaplan JE, Holmes KK, et al. HIV-associated opportunistic infections--going, going, but not gone: the continued need for prevention and treatment guidelines. Clin Infect Dis 2009; 48:609.
  9. Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998; 338:853.
  10. World Health Organization. Rapid advice: diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents, and children. http://whqlibdoc.who.int/publications/2011/9789241502979_eng.pdf?ua=1 (Accessed on March 03, 2014).
  11. Djawe K, Buchacz K, Hsu L, et al. Mortality Risk After AIDS-Defining Opportunistic Illness Among HIV-Infected Persons--San Francisco, 1981-2012. J Infect Dis 2015; 212:1366.
  12. Yangco BG, Buchacz K, Baker R, et al. Is primary mycobacterium avium complex prophylaxis necessary in patients with CD4 <50 cells/μL who are virologically suppressed on cART? AIDS Patient Care STDS 2014; 28:280.