Prophylaxis for HIV-Related Infections: A Work in Progress

Although promising recent advances have been made in antiretroviral therapy, human immunodeficiency virus (HIV) infection remains a lethal problem for infected patients. Opportunistic infections are clearly the most important complication of HIV infection, and they cause considerable morbidity and mortality. Prophylaxis for Pneumocystis carinii pneumonia has been standard care in HIV therapeutics for almost a decade, and the result of this has been increased survival and delay in the onset of other illnesses related to the acquired immunodeficiency syndrome (AIDS) [1]. In the last year, the results of clinical trials showing effective prophylaxis for the most common HIV-related opportunistic infections—systemic fungal, Mycobacterium avium complex, and cytomegalovirus—have been announced, resulting in a dramatic potential to alter the nature of advanced HIV infection.

This issue contains the latest recommendations for prophylaxis of HIV-related infections from the U.S. Public Health Service (USPHS) and the Infectious Diseases Society of America (IDSA) [2]. These differ from previous recommendations in several ways, notably for the prevention of P. carinii pneumonia, M. avium complex disease, and toxoplasmosis. The guidelines are useful because, for the first time, they include recommendations on ways to avoid exposure to opportunistic pathogens (an area often neglected by clinicians) and a review of standard recommendations for chemoprophylaxis. They reinforce the status of trimethoprim-sulfamethoxazole as first-line prophylaxis for P. carinii pneumonia, and, for the first time, they recommend that trimethoprim-sulfamethoxazole …