Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America [open pdf - 6MB]
"Opportunistic infections (OIs) were the first clinical manifestations that alerted clinicians to the occurrence of the acquired immunodeficiency syndrome (AIDS). 'Pneumocystis' pneumonia (PCP), toxoplasma encephalitis, cytomegalovirus (CMV) retinitis, cryptococcal meningitis, tuberculosis, disseminated 'Mycobacterium avium' complex (MAC) disease, and pneumococcal respiratory disease, as well as certain cancers such as Kaposi sarcoma and central nervous system lymphoma, have been hallmarks of AIDS. These OIs, and many more, occurred on average 7 to 10 years after infection with HIV. Until effective antiretroviral therapy (ART) was developed, patients generally survived only 1 to 2 years after the initial manifestation of AIDS. HIV-related OIs have been defined as infections that are more frequent or more severe because of HIV mediated immunosuppression. Starting in the late 1980s, the use of chemoprophylaxis, immunization, and better strategies for managing OIs improved quality of life and lengthened survival of persons with HIV. Early antiretroviral drugs and treatment strategies added further benefit. However, the introduction of highly effective combination ART in the mid-1990s has had the most profound influence on reducing OI-related morbidity and mortality in persons with HIV. Despite the availability of multiple safe, effective, and simple ART regimens, and a corresponding steady decline in the incidence of OIs, the Centers for Disease Control and Prevention (CDC) estimates that more than 40% of Americans with HIV are not effectively virally suppressed. As a result, OIs continue to cause preventable morbidity and mortality in the United States."