Current guidelines for preventing opportunistic infections in HIV disease

Several prophylactic regimens are now standard in the treatment of Pneumocystis carinii pneumonia (PCP) in individuals infected with HIV when CD4+ counts drop below 200. Recent advances in our understanding of the other opportunistic infections that afflict HIV positive patients and the point at which such persons are most at risk have led to the development of preventive strategies at each stage of HIV disease. Interventions have been defined that prevent tuberculosis and herpes infections and are appropriate at any CD4+ count. Other advances include trials of pyrimethamine in combination with dapsone and leucovorin in patients at risk for toxoplasmosis and of rifabutin in the prevention of Mycobacterium avium complex bacteremia. In addition, studies of fluconazole in the prevention of cryptococcal and candidal infections and of oral ganciclovir and an acyclovir precursor as prophylaxis against cytomegalovirus retinitis are under way.