oa SA Pharmaceutical Journal - The prophylaxis of opportunistic infections in HIV-infected adults : clinical



Ultimately the profound immune suppression resulting from Human Immunodeficiency virus (HIV) infection renders patients vulnerable to opportunistic infections (OIs). Patients are vulnerable to some of the OIs even at relatively preserved CD&lt;sub&gt;4&lt;/sub&gt; counts. Other OIs are associated with very low CD&lt;sub&gt;4&lt;/sub&gt; counts. Primary prophylaxis is initiated at a stage when the patient is at risk of the particular infection. Secondary prophylaxis (also called maintenance therapy) is initiated after appropriate treatment of the acute OI, since relapses of some infections are common as long as the patient is severely immune suppressed. Table 1 summarises the prophylactic regimens that are either generally recommended or can be considered for specific patients. The dosages given in the table are for adults. <br>The timely use of highly active antiretroviral therapy (HAART) with concomitant reconstitution of the immune system is the most effective way to prevent opportunistic infections. Unfortunately many patients are only diagnosed with HIV once they are severely immune compromised and need prophylactic therapy until immune reconstitution takes place. Other patients have such profound damage to the immune system that very little immune reconstitution takes place after initiation of HAART and the prophylaxis of OIs need to be continued indefinitely.


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