       Document 0007
 DOCN  M9460007
 TI    Prophylaxis for opportunistic infections in patients with HIV infection.
 DT    9408
 AU    Gallant JE; Moore RD; Chaisson RE; AIDS Service, Johns Hopkins
       University School of Medicine,; Baltimore, MD 21205.
 SO    Ann Intern Med. 1994 Jun 1;120(11):932-44. Unique Identifier : AIDSLINE
       MED/94226433
 AB    OBJECTIVE: To review the efficacy of chemoprophylaxis for opportunistic
       infections in persons infected with human immunodeficiency virus (HIV).
       DATA SOURCES: English-language articles on the prevention of HIV-related
       opportunistic infections were identified through MEDLINE (1985 to 1993)
       and through review of abstracts presented at the International
       Conferences on AIDS, the Interscience Conferences on Antimicrobial
       Agents and Chemotherapy, and the National Conference on Human
       Retroviruses and Related Diseases. STUDY SELECTION: Importance was
       assigned in descending order to controlled clinical trials, uncontrolled
       trials and retrospective studies, and prospective observational studies.
       DATA SYNTHESIS: Persons infected with HIV who are at risk for
       Pneumocystis carinii pneumonia should receive prophylaxis, preferably
       with trimethoprim-sulfamethoxazole. Alternative agents are aerosolized
       pentamidine, dapsone, and dapsone-pyrimethamine. Patients who are
       seropositive for Toxoplasma gondii may benefit from primary prophylaxis
       against toxoplasmosis using trimethoprim-sulfamethoxazole or
       dapsone-pyrimethamine. Life-long secondary prophylaxis is indicated for
       all patients previously treated for toxoplasmic encephalitis. Long-term
       suppressive therapy is required for all patients with cryptococcal
       meningitis and histoplasmosis, and many patients with recurrent mucosal
       candidiasis also benefit from long-term suppression. The role of primary
       prophylaxis of fungal infections, however, is uncertain. Rifabutin has
       been approved to prevent disseminated infection with Mycobacterium avium
       complex and is indicated for all patients with CD4 counts less than
       100/mm3. Chemoprophylaxis with isoniazid for 12 months is indicated in
       all patients infected with HIV who have or are at high risk for M.
       tuberculosis infection. No effective primary prophylactic agent is
       available for cytomegalovirus disease, although several investigational
       drugs are being studied. Acyclovir is effective in decreasing
       recurrences of herpes simplex virus infection. The incidence of common
       bacterial infections is decreased by trimethoprim-sulfamethoxazole.
       Pneumococcal polysaccharide vaccine is recommended for adult patients
       infected with HIV, and Haemophilus influenzae type b conjugate vaccine
       is recommended for children infected with HIV. CONCLUSIONS: A growing
       number of infections related to the acquired immunodeficiency syndrome
       are preventable with currently available agents. Issues of drug
       interactions, toxicity, and cost-effectiveness will become increasingly
       important in the management of patients with advanced HIV disease.
 DE    AIDS-Related Opportunistic Infections/MICROBIOLOGY/*PREVENTION &
       CONTROL/PARASITOLOGY  Human  JOURNAL ARTICLE  REVIEW  REVIEW, ACADEMIC

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

