AIDSWEEKLY Plus; Monday, April 16, 2001
Michael Greer, Staff Medical Writer

NewsRx - The advent of potent antiretroviral therapy for HIV infection has reduced - and possibly eliminated - the need for opportunistic infection prophylaxis, researchers in California argue.

R. Detels and colleagues at the University of California at Los Angeles compared the prevalence of opportunistic infections, occurring either as AIDS defining events or secondary to such events, before and after the widespread use of potent antiretroviral therapy.

The incidence of such infections dropped dramatically from the 1980s and early 1990s, when antiretroviral monotherapy or combination therapy was the mainstay of HIV treatment to the time when more powerful therapies became widely available, the researchers found.

Between 1996 and 1998, the first years in which potent antiretroviral therapy was commonly used, study data showed that the relative hazard (RH) of opportunistic infections as AIDS defining events dropped by 81% compared to years in which antiretroviral monotherapy was the only option (1990-1992). Moreover, the RH for such infections after the onset of full-blown AIDS dropped by 77% over the same period.

Although the only statistically significant drop in prevalence was observed for Pneumocystis carinii pneumonia, trends toward declining frequency were noted for a number of other infections including Mycobacterium avium complex, cytomegalovirus disease, and esophageal candidiasis, Detels et al. said.

The decrease in opportunistic infection risk cannot be attributed to increased prophylactic therapy, the use of which has actually declined over the last decade ("Effectiveness of potent antiretroviral therapies on the incidence of opportunistic infections before and after AIDS diagnosis," AIDS 2001 Feb 16;15(3):347-55.

"The hazard of [opportunistic infections] in the era of potent antiretroviral therapy has declined dramatically compared with the era of monotherapy, despite the concurrent decrease in the use of prophylactic drugs," Detels and colleagues concluded. "Physicians should consider whether it is necessary to include prophylactic drugs as part of the complex drug regimen for patients on potent antiretroviral therapy."

The corresponding author for this report is R. Detels, University of California at Los Angeles, School of Public Health, Box 951772, Los Angeles, CA 90095, USA.

A search at NewsRx.net using the search term "AIDS and HIV opportunistic infections" yielded 160 articles in 6 specialized reports.

Key points reported in this study include:

• The era of potent antiretroviral therapy has sharply reduced the frequency of opportunistic infections
  
  
• The incidence of such infections as AIDS defining events has dropped by more than 80% since the mid-1980s
  
  
• This reduced prevalence has taken place even as the use of infection prophylaxis has dropped
  

This article was prepared by AIDS Weekly editors from staff and other reports.

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