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Opportunistic Infections Update

December, 1998

With the availability of highly active antiretroviral therapy (HAART), there has been a dramatic decrease in the incidence of many HIV-related infections (called Opportunistic Infections or OIs). While clearly this is great news, it has made studying new therapies to treat or prevent common OIs very difficult. This is a serious concern for people experiencing OIs and in need of more and better therapies.

While there are only a few studies looking at new therapies for OIs, many are examining when it might be safe to stop taking OI prevention or maintenance (to prevent relapse of the disease) therapies. Such studies test the value of improvements in immune status seen as a consequence of HAART. Preliminary results from these studies will not be available until sometime in 1999. In the upcoming years, we can probably expect to see further research on HIV-related conditions focusing on questions of stopping preventative and maintenance therapy, issues of treating hepatitis and metabolic consequences of HIV disease and therapy, including body composition changes (e.g. lipodystrophy) and wasting syndrome.

While HAART has decreased the incidence of most OIs (pneumocystis carinii pneumonia (PCP), cytomegalovirus (CMV), mycobacterium avium complex (MAC), etc.) it has not reduced the incidence of all HIV-related infections. One study conducted in Spain showed that advances in anti-HIV drug availability and effectiveness has not decreased the incidence of tuberculosis (TB). The study showed that the incidence of TB has remained constant between 1988-1998 despite improving standards of care for treating HIV. It is not clear whether effective antiviral therapy has affected the severity or treatability of tuberculosis. Another study conducted in France shows that HAART has only had modest effects in reducing the incidence of bacterial infections that require hospitalization. Somewhat surprisingly, about half of the cases were among people with CD4+ counts of over 200 cells.

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