Opportunistic Infections

Opportunistic Infections is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Potent ART has decreased the incidence, changed the manifestations, and improved the outcome of OIs. However, OIs are still a common presentation of unrecognized HIV infection.
  • A clinical syndrome associated with the immune enhancement induced by potent ART, IRIS, generally presents as local inflammatory reactions. Examples include recurrent symptoms of cryptococcal meningitis, paradoxical reactions with TB reactivation, localized Mycobacterium avium complex (MAC) adenitis, aggravation of hepatitis viral infection, and CMV vitreitis soon after the initiation of potent ART.
  • In the case of IRIS, ART is usually continued, and the addition of low-dose steroids might decrease the degree of inflammation. TB and cryptococcal meningitis are the only OIs for which delay of ART is recommended to prevent IRIS.
  • Additional details with updates may be found in the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.1

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