Clinical Review

Recent advances: HIV infection-II

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7080.579 (Published 22 February 1997) Cite this as: BMJ 1997;314:579
  1. Claire Beisera
  1. a Institute of Human Virology and Division of Infectious Diseases University of Maryland Medical System Adult HIV Program Box 174 Baltimore MD 21201-1595 USA

    Introduction

    Despite recent impressive advances in antiretroviral therapy and the hope they bring for further delaying the onset of AIDS and even for cure of HIV infection, we are left with the need to prevent and treat the opportunistic complications that come with a diagnosis of AIDS. Worldwide, most people infected with HIV do not have access to antiretroviral drugs or to treatment and prophylaxis for many of the complications of HIV infection. In the developing world, therefore, prevention of HIV infection is receiving attention. This article summarises some recent advances in the aetiology, treatment, and prophylaxis of the opportunistic complications of HIV infection as well as progress in HIV prevention in the developing world.

    Opportunistic infections

    The spectrum of opportunistic infections depends on geography. Pneumocystis carinii pneumonia, for example, is common in the developed world, but not in Africa, where tuberculosis is by far the most common opportunistic problem.1 Penicillium marneffei infection has recently emerged as a major opportunistic mycosis in northern Thailand,2 and visceral leishmaniasis occurs in several parts of the Mediterranean and Latin America.3 The profile of opportunistic infections has changed since the beginning of the epidemic. In the developed world, survival has improved with the availability of antiretrovirals and prophylactic agents,4 and the opportunistic infections that occur with more advanced immunosuppression, such as cytomegalovirus retinitis and Mycobacterium avium complex infections have become more common.5 6 Furthermore, many opportunistic infections seem to be occurring at lower CD4 counts than earlier in the epidemic,7 highlighting again the successes of prophylactic measures and antiretroviral agents.

    In 1995, the US Public Health Service published comprehensive guidelines for the prophylaxis of infections in people infected with HIV.8 Prophylaxis of Pneumocystis carinii pneumonia, tuberculosis, and toxoplasmosis have already been established as important measures that are highly cost effective. …

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