What is the focus of HIV guidelines on the prevention of opportunistic infections?

Updated: Mar 09, 2021
  • Author: Justin R Hofmann, MD; Chief Editor: John Bartlett, MD  more...
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Besides causing morbidity and mortality alone, OI accelerate the progression of HIV and increase the HIV viral load; ulcerative lesions such as those caused by syphilis can facilitate the spread of HIV. [1, 6, 7, 8]  Thus, guidelines emphasize ART should be used together with prophylaxis, treatment, secondary prophylaxis, or continuation therapy of OI. Timing of ART warrants thoughtful consideration and knowledge of immunologic, psychosocial, and economic considerations in the specific patient.

Despite increasingly widespread and targeted HIV screening, many HIV infections continue to be diagnosed late and after OI have already developed. [15]  Favorably for these patients, initiating ART in patients with CD4 counts below 350 cells/uL results in a significant decline in the risk for AIDS-related morbidity and mortality. [16, 17, 18, 19, 20, 21]  

Guidelines from the US Centers for Disease Control and Prevention, National Institutes of Health, and the Infectious Diseases Society of America (CDC/NIH/IDSA) emphasize early HIV detection and the supervised administration of ART to maintain cellular immunity before reaching advanced stages of disease. The incidence of OI has fallen dramatically since widespread use of ART began.

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