Fifth International Congress

Drug Therapy in HIV Infection


22-26 October, 2000
Glasgow, UK

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OPPORTUNISTIC INFECTIONS: WHAT’S NEW?

H. Furrer
Infectious Diseases, University Hospital, CH-3010 Bern, Switzerland

Int Cong Drug Therapy HIV 2000 Oct 22-26;5:Abstract No. PL5.1
AIDS 2000, Oct 22-26;14(Suppl. 4);S5

Antiretroviral combination therapy (ART) has markedly changed the natural course of HIV-infection:

  1. Overall the incidence of opportunistic infections (OI) has declined. After starting ART this decline in incidence follows different patterns. While there is sharp decline for OIs such as Pneumocystis carinii pneumonia (PCP) and Toxoplasma encephalitis or Kaposi Sarcoma , incidence of others (such as mycobacterial diseases or cytomegalovirus disease) remains high during the first three months declining afterwards. Achieving a CD4 count of 200cells/µl after six months of ART is a valuable marker for low risk of OI afterwards.

  2. Immunerestitution disease: Clinical manifestations of OI may be different in patients on ART. This may be attributed to immunopathogenic mechanisms due to immunereconstitution on ART.

  3. New recommendations on prophylaxis and maintenance therapy: Taking into account the decreased risk of OIs in patients on ART, new recommendations about discontinuation of prophylaxis and maintenance therapy seem warranted. Numerous studies addressing the safety of discontinuation are being performed. Criteria for discontinuation such as CD4 count threshold values, time above this threshold values, nadir CD4 count and virologic response to ART have to be evaluated for the most frequent OIs. Strong data in favour of discontinuation of primary prophylaxis against PCP, Toxoplasma encephalitis and M.avium infection have been published. Discontinuation of maintenance therapy against PCP, CMV retinitis and M.avium may be safe too in selected patients, but needs further evaluation.

Presenting author: H. Furrer

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2000-10-22
PL5-1

Originally published in AIDS Volume 14, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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