[2008 prevention of opportunistic infections in HIV-infected adolescents and adults guidelines. Recommendations of GESIDA/National AIDS Plan AIDS Study Group (GESIDA) and National AIDS Plan].

OBJECTIVE: To provide an update of 2004 Guidelines from the Spanish AIDS Study Group (GESIDA) and the National AIDS Plan (PNS) committee on the prevention of opportunistic infections in adult and adolescent HIV-infected patients.
METHODS: These consensus recommendations have been produced by a group of experts from GESIDA and/or the PNS after reviewing the 2004 document and the scientific advances in this field in the last four years. The system used by the Infectious Diseases Society of America and the United States Public Health Service has been used to classify the strength and quality of the data.
RESULTS: This document provides a detailed review of the measures for the prevention of infections caused by parasites, fungi, viruses, mycobacteria and bacteria in the context of HIV infection. Due to the increase in recent years of HIV-infected immigrants, the prevention of tropical infections have been incorporated. Recommendations are given for preventing exposure and for primary and secondary prophylaxis for each group of pathogens. In addition, criteria are established for the withdrawal of prophylaxis in patients who respond well to highly active antiretroviral therapy (HAART).
CONCLUSIONS: HAART is the best strategy for the prevention of opportunistic infections in HIV-positive patients. Nevertheless, prophylaxis is still necessary in countries with limited economic resources and also in developed countries, where late presenters are common, in immunosuppressed patients who refuse to take or who cannot take HAART, in those in whom HAART is not effective, and in the small group of infected patients with inadequate recovery of CD4+ T-lymphocyte counts despite good inhibition of HIV replication induced by HAART.