Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- Part XI The Susceptible Host
- Part XII HIV
- 96 HIV Infection: Initial Evaluation and Monitoring
- 97 HIV-1 Infection: Antiretroviral Therapy
- 98 Immune Reconstitution Inflammatory Syndrome
- 99 Differential Diagnosis and Management of Opportunistic Infections Complicating HIV Infection
- 100 Prophylaxis of Opportunistic Infections in HIV Infection
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
100 - Prophylaxis of Opportunistic Infections in HIV Infection
from Part XII - HIV
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- Part XI The Susceptible Host
- Part XII HIV
- 96 HIV Infection: Initial Evaluation and Monitoring
- 97 HIV-1 Infection: Antiretroviral Therapy
- 98 Immune Reconstitution Inflammatory Syndrome
- 99 Differential Diagnosis and Management of Opportunistic Infections Complicating HIV Infection
- 100 Prophylaxis of Opportunistic Infections in HIV Infection
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
Summary
The use of infection prophylaxis has been a major advance in human immunodeficiency virus (HIV) disease. Even prior to the introduction of potent antiretroviral therapies, the morbidity and mortality rates were decreasing presumably due to recognition of pathogens and use of prophylaxis for opportunistic infections. The Centers for Disease Control and Prevention (CDC) published the 2002 update of the United States Public Health Service/Infectious Diseases Society of America guidelines for opportunistic infection prophylaxis in HIV disease. The major update pertains to the data generated since the 1999 edition regarding the safety of discontinuing both primary and secondary prophylaxis for several opportunistic infections. There are some minor differences with regard to duration of time the CD4 count increases above a set threshold before stopping prophylaxis and the duration of treatment for pathogen-specific diseases, most of which can be attributed to the study designs of the prophylaxis discontinuation trials for that specific pathogen.
Primary prophylaxis is that given before development of an infection. The best known and most effective is trimethoprim–sulfamethoxazole (TMP-SMX) prophylaxis against Pneumocystis jiroveci pneumonia, formerly known as Pneumocytis carinii (PCP). TMP-SMX is 90% or more effective and is estimated to add a year to survival in late HIV disease. Other prophylaxes that are highly effective (≥70% efficacy) have now become standard of care in HIV disease: prophylaxis against tuberculosis (TB) if there has been exposure or a positive tuberculin skin test and against disseminated Mycobacterium avium complex (MAC) infection and toxoplasmosis.
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- Information
- Clinical Infectious Disease , pp. 721 - 730Publisher: Cambridge University PressPrint publication year: 2008