Inpharma 1291 - 9 Jun 2001 Treatment strategies for HIV- related opportunistic infections The treatment and prophylaxis of opportunistic infections ‘remains important’ in patients with HIV infection who are severely immunosuppressed, say Drs Ian Weller and IG Williams. First, Drs Weller and Williams note that prophylaxis against opportunistic infections such as Pneumocystis carinii pneumonia ‘is essential after a first attack (secondary prophylaxis) but is also recommended for all patients once their CD4 cell counts falls [sic] below 200 × 10 6 /l (primary prophylaxis)’. Cotrimoxazole [trimethoprim/sulfamethoxazole] is the agent of choice. Cerebral toxoplasmosis is the ‘commonest manifestation’ of toxoplasma infection and responds well to first-line combination therapy with sulfadiazine or clindamycin plus pyrimethamine, say Drs Weller and Williams. They go on to say that primary prophylaxis, using agents such as cotrimoxazole or dapsone plus pyrimethamine, is recommended for patients with positive serology who have a CD4+ cell count of < 200 × 10 6 /L. Symptomatic therapy for cryptosporidiosis Patients infected with cryptosporidiosis should receive symptomatic treatment with antidiarrhoeal and antiemetic agents, as well as fluid, electrolyte and nutritional support, say Drs Weller and Williams. Opportunistic viral infections (including herpes simplex and cytomegalovirus infection) respond to aciclovir, ganciclovir, cidofovir and foscarnet treatment. Prophylaxis is appropriate following severe infection and in patients experiencing increasingly severe and frequent recurrences. Relapse of fungal opportunistic infections (candidiasis and cryptococcosis) is common in patients who remain severely immunosuppressed, and maintenance therapy is required. Be aware of potential drug interactions For the treatment of tuberculosis in HIV infection, clinicians should be aware of potential ‘drug interactions between rifamycins (rifampicin and rifabutin) and antiretroviral drugs, particularly the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors’, warn Drs Weller and Williams. Primary prophylaxis against Mycobacterium avium complex should be considered in patients with HIV infection who have a CD4+ cell count of < 75 × 10 6 /L, they add. Finally, salmonella infections should be treated with cotrimoxazole or ciprofloxacin and campylobacter with ciprofloxacin. Weller IVD, et al. Treatment of infections. BMJ 322: 1350-1354, 2 Jun 2001 800861508 1 Inpharma 9 Jun 2001 No. 1291 1173-8324/10/1291-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Treatment strategies for HIV-related opportunistic infections

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Inpharma 1291 - 9 Jun 2001

Treatment strategies for HIV-related opportunistic infections

The treatment and prophylaxis of opportunisticinfections ‘remains important’ in patients with HIVinfection who are severely immunosuppressed, say DrsIan Weller and IG Williams.

First, Drs Weller and Williams note that prophylaxisagainst opportunistic infections such as Pneumocystiscarinii pneumonia ‘is essential after a first attack(secondary prophylaxis) but is also recommended for allpatients once their CD4 cell counts falls [sic] below 200 ×106/l (primary prophylaxis)’. Cotrimoxazole[trimethoprim/sulfamethoxazole] is the agent of choice.

Cerebral toxoplasmosis is the ‘commonestmanifestation’ of toxoplasma infection and respondswell to first-line combination therapy with sulfadiazineor clindamycin plus pyrimethamine, say Drs Weller andWilliams. They go on to say that primary prophylaxis,using agents such as cotrimoxazole or dapsone pluspyrimethamine, is recommended for patients withpositive serology who have a CD4+ cell count of < 200× 106/L.

Symptomatic therapy for cryptosporidiosisPatients infected with cryptosporidiosis should

receive symptomatic treatment with antidiarrhoeal andantiemetic agents, as well as fluid, electrolyte andnutritional support, say Drs Weller and Williams.

Opportunistic viral infections (including herpessimplex and cytomegalovirus infection) respond toaciclovir, ganciclovir, cidofovir and foscarnet treatment.Prophylaxis is appropriate following severe infection andin patients experiencing increasingly severe andfrequent recurrences. Relapse of fungal opportunisticinfections (candidiasis and cryptococcosis) is commonin patients who remain severely immunosuppressed,and maintenance therapy is required.

Be aware of potential drug interactionsFor the treatment of tuberculosis in HIV infection,

clinicians should be aware of potential ‘drug interactionsbetween rifamycins (rifampicin and rifabutin) andantiretroviral drugs, particularly the protease inhibitorsand the non-nucleoside reverse transcriptase inhibitors’,warn Drs Weller and Williams. Primary prophylaxisagainst Mycobacterium avium complex should beconsidered in patients with HIV infection who have aCD4+ cell count of < 75 × 106/L, they add. Finally,salmonella infections should be treated withcotrimoxazole or ciprofloxacin and campylobacter withciprofloxacin.Weller IVD, et al. Treatment of infections. BMJ 322: 1350-1354, 2 Jun2001 800861508