High Risk of Opportunistic Infections Shortly After Beginning HAART

Several recent reports have pointed out a higherthan expected risk of AIDS illnesses during the first 3months on potent antiretroviral therapy in subjectshaving low CD4+ counts at baseline. Although someevents represent relapses of previous infections,such as recurrent CMV retinitis, others constitute thefirst AIDS-defining disease in those individuals. Intheir report, Michelet et al (AIDS 1998; 12: 1815-22)recorded 18 clinical events during the first 2 monthson HAART in subjects showing both a dramatic virologicaland immunological response. CMV retinitisand mycobacterial diseases, either tuberculosis orMAC disseminated infection, were the most commonclinical events in this population. In previous reportsin The Lancet (see Jacobson et al. Lancet 1997; 349:1443-5; and Race et al. Lancet 1998; 351: 252-5) itwas noticed that acute clinical presentations of previouslylatent pathogens, might occur in AIDS patientsearly after beginning HAART. During the 4th InternationalCongress on Drug Therapy in HIV Infection(Glasgow, November 1998), at least five groupsrecorded similar observations in their cohorts of patientswho underwent HAART. Episodes of herpeszoster, CMV, TB, but also CNS toxoplasmosis andPCP were seen in most instances.