Approach to opportunistic illness in the HAART era

AIDS-defining opportunistic illness(OIs) are the major cause of mortality among persons infected with HIV. The incidences of many OIs are decreasing because of advances in HIV-related therapy. These decreases have been attributed to successful OI prophylaxis and the use of highly active antiretroviral therapy(HAART). Patients who have responded to HAART and have a sustained increase in CD4+ cell counts appear to be well protected from OIs. Thus, a strategy of discontinuation of chemoprophylaxis for patients whose immunity has improved seems logical. HAART is the most effective approach to preventing OIs. However, OIs are still occurring, especially when patients access care late during the course of disease. Prophylaxis and treatment against specific OIs continues to provide survival benefits even among persons who are receiving HAART.