Discontinuation of Prophylaxis Against Opportunistic Infections in HIV-Infected Persons Receiving Potent Combination Antiretroviral Therapy

Prophylaxis and maintenance therapy against opportunistic infections (OI) are a mainstay in the management of HIV-infected patients and have led to a significant improvement in the quality of life and survival. In the past few years potent combination antiretroviral therapy became available. This treatment leads to an improvement in the immune function and is associated with a marked decrease in the incidence of opportunistic infections. This has raised the question whether primary or secondary prophylactic therapies may be discontinued without the risk of new or recurrent OI’s. This issue is being addressed by several study groups. For each opportunistic infection, parameters that might influence the decision to discontinue primary or secondary prophylaxis should be clearly defined and evaluated. Stopping primary prophylaxis against Pneumocystis cariniipneumonia in patients with a sustained rise in CD4-lymphocyte count above 200/µL has proven safe. Discontinuation of primary prophylaxis against Mycobacterium avium disease and of maintenance therapy against cytomegalovirus retinitis might also be safe in certain patients receiving potent combination antiretroviral therapy.