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Continued vigilance required to combat HIV–associated opportunistic infections
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Effective prophylaxis and antiretroviral therapy have reduced the number of HIV–associated opportunistic infections in the United States. However, the shifting trends and decreases in these infections may lead to a false sense of security among clinicians.
John T. Brooks, MD, of the National Centers for HIV, Hepatitis, Tuberculosis and STD Prevention at the CDC, recently contributed to an editorial about opportunistic infections that was published in Clinical Infectious Diseases. He said that Pneumocystis pneumonia, Mycobacterium avium complex and Candida esophagitis remain among the most common opportunistic infections. “The big players we were seeing 20 years ago are still around today,” he told Infectious Disease News. “The change in epidemiology has been the precipitous decline in incidence.”
Because of the decline, clinicians working today may not have had as much exposure to opportunistic infections as they did in the past. As a result, they may not be as well versed in prevention and treatment protocols as they once were.
Later this year, a comprehensive set of guidelines for the treatment of HIV–associated opportunistic infections will be published in Morbidity and Mortality Weekly Report. Recommendations for adults, adolescents and children will be included. A draft of the guidelines is currently available online.
Infections at presentation
Opportunistic infections remain one of the leading ways that patients with HIV come to medical attention, according to Brooks. “It is not uncommon that a patient is first diagnosed with HIV infection late in the course of the disease, when they present with an opportunistic infection,” he said.
The frequency of patients presenting who do not know their serostatus indicates the need for more comprehensive testing programs. “Knowing your status as early as possible after infection occurs is paramount to preventing opportunistic infection,” Brooks said. “With contemporary ART, we can now delay by years – even decades – extreme immunosuppression and, therefore, the risk of acquiring an opportunistic infection. It is really the prevention aspect that is so important here because these infections are preventable.” – by Rob Volansky
Clin Infect Dis.2009;48:609-611.
For more information on the Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents, visit http://www.aidsinfo.nih.gov/contentfiles/Adult_OI.pdf.