Prophylaxis of opportunistic infections in persons with HIV infection

BACKGROUND: Morbidity and mortality associated with human immunodeficiency virus infection and the acquired immunodeficiency syndrome is most often related to associated opportunistic infections. OBJECTIVE: To review the prophylaxis of common opportunistic infections in patients with human immunodeficiency virus. SUMMARY: Prophylactic treatment for Pneumocystis carinii pneumonia should begin when the CD4 count falls below 200 cells per microL. Recommended treatment consists of trimethoprim 160 mg and sulfamethoxazole 800 mg daily, but other regimens have been successfully used. This regimen appears to also prevent the development of toxoplasmic encephalitis. Fluconazole 100 mg once or twice weekly can prevent oral and esophageal candidiasis, but its efficacy against life-threatening fungal infections is unproved. Rifabutin 300 mg daily can delay the development of disseminated Mycobacterium avium complex infection. Daily therapy with 300 mg of isoniazid for at least 9 months is recommended for persons at risk for tuberculosis. CONCLUSIONS: Prevention of opportunistic infections can prolong the lives of persons infected with human immunodeficiency virus. Effective regimens are available for preventing some of these infections, and studies are in progress to establish optimum regimens for others.