Opportunistic infections and coinfections: focus on fungi and hepatitis

William G Powderly MD

One of the most prominent features of the highly active antiretroviral therapy (HAART) era has been the positive impact on opportunistic infections (OIs).In particular, among patients with good immunologic and virologic responses to HAART, it has proved possible to stop primary prophylaxis and maintenance therapy in patients with previously active infections.

Indeed, the guidelines issued by the US Public Health Service and the Infectious Diseases Society of America currently recommend that following a rise in CD4+ cell count and control of viral replication, one can stop primary and secondary prophylaxis for virtually all OIs.

Most of the supporting data come from cohort studies and some prospective studies that examined the most common OIs: pneumocystis carinii pneumonia, disseminated mycobacterium avium complex infection, and cytomegalovirus retinitis. However, less information has been available for fungal infections, and some experts have expressed reservations as to whether it is indeed safe to stop secondary prophylaxis in patients with prior systemic infections. Three studies presented at the XIV International AIDS Conference in Barcelona added additional support for current recommendations.

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