The Management of Opportunistic Infections in the Era of Highly Active Antiretroviral Therapy

Major improvements have occurred in HIV infection in recent years. Potent antiretroviral therapies have reduced dramatically the number of subjects with low CD4 counts and high viral burden. As result, most HIV-infected persons are no longer at risk to develop opportunistic infections and therefore primary prophylaxis is rarely recommended. Moreover, in patients who were receiving secondary prophylaxis after suffering a first episode of Pneumocystis carinii pneumonia, cytomegalovirus retinitis or toxoplasmosis of the central nervous system, recent evidences support the discontinuation of preventive medication as soon as the increase in CD4+ cell count produced by the newly potent antiretroviral drugs reach a certain threshold. Any reduction in the number of drugs prescribed in those patients is of great benefit in terms of quality of life and reduction in the risk of toxicities and drug interactions.