Opportunistic infections: an update.

With highly active antiretroviral therapy (HAART), the overall incidence of opportunistic infections (OIs) has declined and survival after an AIDS-defining event has improved. However, rates of mycobacterial diseases and cytomegalovirus (CMV) disease remain high for the first 3 months before declining. Achieving a CD4 count of 200 cells/ micro l after 6 months of HAART is a valuable marker for a subsequent low risk of OIs. Different clinical manifestations of OIs may be attributable to immunopathogenic mechanisms linked to immune reconstitution on HAART. The recommendations on prophylaxis and maintenance therapy need to be redefined to allow for the decreased risk of OIs in HAART-treated patients. There are strong data in favour of discontinuing primary prophylaxis against Pneumocystis carinii pneumonia, toxoplasma encephalitis and Mycobacterium avium infection.