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12 : Human Immunodeficiency Virus-Related Opportunistic Infections in the Era of Highly Active Antiretroviral Therapy

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Abstract:

In the late 1970s, the first clues that an epidemic due to human immunodeficiency virus type 1 (HIV-1) was beginning to unfold were the opportunistic infections that clinicians recognized in previously healthy individuals who, by the laboratory parameters available and in use at the time, appeared to have no underlying disease. Opportunistic infections continue to occur in HIV-infected individuals in the United States in 2000. Epidemiologic data concerning the frequency of opportunistic infections in the era of highly active antiretroviral therapy, as well as specific studies of clinical outcome for patients enrolled in clinical trials, clearly demonstrate that highly active antiretroviral therapy (HAART) reduces susceptibility to opportunistic infection. Viral load is an independent predictor of the likelihood of developing opportunistic infections, but the risk of developing such complications is still effectively predicted by the current CD4 T-lymphocyte count. The revised United States Public Health Service-Infectious Disease Society of America guidelines on prophylaxis of opportunistic infections, which were published in August 1999, continue to stress the importance of initiating primary prophylaxis for pneumocystosis, complex disease, toxoplasmosis, and tuberculosis for patients who meet the well-established criteria.

Citation: Masur H. 2000. Human Immunodeficiency Virus-Related Opportunistic Infections in the Era of Highly Active Antiretroviral Therapy, p 165-186. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch12
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Figures

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Figure 1.

Relationship of CD4 T-lymphocyte count to occurrence of opportunistic infection. The distribution of CD4 T-lymphocyte counts at diagnosis of opportunistic infection from 1990 to 1994 is shown. (Adapted from reference .) MAC, complex; CMV ret, CMV retinitis; Histo, Histoplasmosis; Toxo, toxoplasmosis; Crypt, cryptococcosis; Cocci, coccidiomycosis; Cand Esoph, Candida esophagitis; Cryptospor, cryptosporidiosis; dTB, disseminated tuberculosis; HSV, Herpes simplex virus; Strep Pneumo, PTB, pulmonary tuberculosis; Cervical CH, cervical carcinoma.

Citation: Masur H. 2000. Human Immunodeficiency Virus-Related Opportunistic Infections in the Era of Highly Active Antiretroviral Therapy, p 165-186. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch12
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Image of Figure 2.
Figure 2.

Incidence of HIV-related opportunistic infections in CDC Adult Spectrum of Disease study. Adapted from reference 18 and reprinted from the ( ) with pennission. pt-yrs, patient-years.

Citation: Masur H. 2000. Human Immunodeficiency Virus-Related Opportunistic Infections in the Era of Highly Active Antiretroviral Therapy, p 165-186. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch12
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Image of Figure 3.
Figure 3.

Percentage of persons with CD4 + T-lymphocyte counts <500 cells/l who had antiretroviral therapy (ART) prescribed, by year (Adult/Adolescent Spectrum of HIV Disease project, 1992 to 1997). Adapted from reference .

Citation: Masur H. 2000. Human Immunodeficiency Virus-Related Opportunistic Infections in the Era of Highly Active Antiretroviral Therapy, p 165-186. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch12
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Image of Figure 4.
Figure 4.

Percentage of persons with CD4 T-Lymphocyte counts of <2001/l who had prophylaxis for pneumonia prescribed, by year (Adult/ Adolescent Spectrum of HIV Disease project, 1992 to 1997). Adapted from reference . TMP-SMX, trimethoprim-sulfamethoxazole.

Citation: Masur H. 2000. Human Immunodeficiency Virus-Related Opportunistic Infections in the Era of Highly Active Antiretroviral Therapy, p 165-186. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch12
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Image of Figure 5.
Figure 5.

Percentage of persons with CD4 T.lymphocyte counts of <50 cells/l. d who had prophylaxis for complex prescribed, by year (Adult/ Adolescent Spectrum of HIV Disease project, 1992 to 1997). Adapted from reference .

Citation: Masur H. 2000. Human Immunodeficiency Virus-Related Opportunistic Infections in the Era of Highly Active Antiretroviral Therapy, p 165-186. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch12
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References

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Tables

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Table 1.

Prophylaxis to prevent the first episode of opportunistic disease in adults and adolescents infected with HIV

Citation: Masur H. 2000. Human Immunodeficiency Virus-Related Opportunistic Infections in the Era of Highly Active Antiretroviral Therapy, p 165-186. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch12

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