Prevention of Opportunistic Infections in HIV/AIDS

Excerpt

Opportunistic infections (OI) are a significant cause of morbidity and mortality in patients with HIV/AIDS. Although the incidence of OI has reduced since the introduction of highly active antiretroviral therapy (ART) in 1995, it continues to add to the burden of HIV-related hospitalizations and deaths in patients. This is particularly true in patients who have not received HAART therapy or who have been non-compliant to it. These infections generally lack the virulence and pathogenicity to cause disease in immunocompetent hosts and are hence an uncommon phenomenon.However, due to the immunodeficiency, the risk of OI in HIV/AIDS is substantially increased, particularly in the absence of ART and antimicrobial prophylaxis.

There is a progressive decrease in CD4+ counts in HIV/AIDS when left untreated. CD4+ cells play an important role in mounting an immune response against infections. These cells release cytokines that lead to the activation of antigen-presenting cells, phagocytic cells, natural killer cells, and cytotoxic T cells. They also support the conversion of B-lymphocytes into long-lived plasma cells and memory B cells. A decrease in CD4+ T cell count thus leads to a decline in both humoral and cell-mediated immunity. Ultimately it predisposes patients to a higher risk of contracting opportunistic diseases due to viruses, bacteria, fungi, and protozoa. As the dogma of medicine is "Prevention is better than cure", preventing opportunistic infections in HIV/AIDS patients is paramount to seeing a decrease in both disease burden and associated mortality. In this review article, we discuss the methods of preventing opportunistic infections in HIV/AIDS patients.