Prophylaxis of opportunistic infections

Opportunistic infections (OIs) are the hallmark of the immunodeficiency associated with HIV infections. In the mid-1990s, widespread use of prophylaxis strategies improved the morbidity and mortality of AIDS, and the guidelines for the prevention of most infections have been promulgated. More recently, with the introduction of potent antiretroviral therapy, there has been a dramatic change in clinical outcome of many OIs such that antiretroviral therapy should be regarded as standard treatment for any OI. In addition, the immune reconstitution that follows successful inhibition of HIV replication raises the question of withdrawal of specific antimicrobial prophylaxis. In fact, diseases that previously required lifelong maintenance therapy may be potentially curable with effective antiretroviral therapy. In this article, the authors update clinicians on the current state of the art of prophylaxis of OIs in the era of potent treatment for HIV.