Complications of HIV Disease or Treatment
Prophylaxis Against Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus

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ABSTRACT

This article outlines the current official recommendations for the prevention of opportunistic disease in adults and adolescents infected with human immunodeficiency virus, including specific guidelines for discontinuing primary and secondary prophylaxis when immune reconstitution has occurred as a result of highly active antiretroviral therapies. The recommendations, developed by the U. S. Public Health Service and the Infectious Diseases Society of America for clinicians and healthcare providers, were originally published in 1995 and revised in 1997, 1999, and 2002. The 2002 recommendations are summarized in this article.

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Preventing Exposure

Recommendations by some authorities to avoid having HIV-infected patients who are at high risk for P carinii pneumonia (PCP) share a room with a patient who has PCP have not been supported by recent research. Person-to-person transmission of PCP may occur occasionally, but it does not constitute the major route of human transmission (CIII).

Indications: Primary and Secondary Prophylaxis

Prophylaxis is indicated for HIV-infected individuals with a CD4 count less than 200 cells/ mm3 (AII) or a history of oropharyngeal candidiasis (AII). Consider

Indications

All patients with HIV disease with a CD4 count of 200 cells/mm3 or greater should receive a single dose of 23-valent polysaccharide pneumococcal vaccine 0.5 mL intramuscularly (IM) if they have not received this vaccine during the previous 5 years (BIII).

Immunization can be considered for patients with CD4 counts of less than 200/mm3, and then they should be revaccinated when CD4 counts increase to greater than 200 cells/mm3 in response to HAART (CIII).

The duration of the protective effect of

Preventing Exposure

Persons infected with HIV cannot avoid exposure to C neoformans, which is a common environmental fungus. No evidence exists that exposure to pigeon droppings is associated with an increased risk for developing cryptococcosis.

Indications

Routine testing of asymptomatic persons for the cryptococcal antigen is not recommended because of low probability that the results will affect clinical decisions (DIII). Fluconazole and itraconazole can decrease the incidence of infection in patients with advanced HIV

Management of Prophylaxis for Opportunistic Infections in Pregnancy

Recommendations for prophylaxis to prevent opportunistic infections in adults and adolescents should be followed with slight modifications during pregnancy (Table 2).1., 6. Prophylactic regimens to prevent PCP, MTB, MAC, and toxoplasmosis are similar to those for nonpregnant individuals. Primary prophylaxis against cytomegalovirus, oral candidiasis, and invasive fungal infections is not recommended routinely for pregnant or nonpregnant individuals because of drug toxicity, side effects, and

References (6)

  • Centers for Disease Control and Prevention

    Guidelines for preventing opportunistic infections among HIV-infected persons–2002

    MMWR Recomm Rep

    Recommendations of the U. S. Public Health Service and the Infectious Diseases Society of America

    (2002)
  • Centers for Disease Control and Prevention

    Report of the NIH Panel to define principles of therapy of HIV infection and guidelines for use of antiretroviral agents in HIV-infected adults and adolescents

    MMWR Recomm Rep

    (1998)
  • Centers for Disease Control and Prevention

    Updated guidelines for the use of rifabutin or rifampin for the treatment and prevention of tuberculosis among HIV-infected patients taking protease inhibitors or nonnucleoside reverse transcriptase inhibitors

    MMWR Morb Mortal Wkly Rep

    (2000)
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