Opportunistic Infections

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

To view the entire topic, please or .

The Washington Manual is an award-winning, complete mobile solution for nurses and students. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. Explore these free sample topics:

-- The first section of this topic is shown below --

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. Unmasking IRIS is when a patient develops symptoms of an OI while on ART treatment with no previous symptoms or indications of the patient having that OI previous to immune reconstitution. Paradoxical IRIS is when a patient is known to have a particular OI and worsens while on ART with immune reconstitution. 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 starting 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

-- To view the remaining sections of this topic, please or --

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. Unmasking IRIS is when a patient develops symptoms of an OI while on ART treatment with no previous symptoms or indications of the patient having that OI previous to immune reconstitution. Paradoxical IRIS is when a patient is known to have a particular OI and worsens while on ART with immune reconstitution. 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 starting 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

There's more to see -- the rest of this topic is available only to subscribers.