Furrer Hansjakob, Fux Christoph
Division of Infectious Diseases, University Hospital, Inselspital PKT2 B, CH 3010 Bern, Switzerland.
J HIV Ther. 2002 Feb;7(1):2-7.
With highly active antiretroviral therapy (HAART), the overall incidence of opportunistic infections (OIs) has declined and survival after an AIDS-defining event has improved. However, rates of mycobacterial diseases and cytomegalovirus (CMV) disease remain high for the first 3 months before declining. Achieving a CD4 count of 200 cells/ micro l after 6 months of HAART is a valuable marker for a subsequent low risk of OIs. Different clinical manifestations of OIs may be attributable to immunopathogenic mechanisms linked to immune reconstitution on HAART. The recommendations on prophylaxis and maintenance therapy need to be redefined to allow for the decreased risk of OIs in HAART-treated patients. There are strong data in favour of discontinuing primary prophylaxis against Pneumocystis carinii pneumonia, toxoplasma encephalitis and Mycobacterium avium infection.
随着高效抗逆转录病毒疗法（HAART）的应用，机会性感染（OIs）的总体发病率有所下降，艾滋病确诊事件后的生存率也有所提高。然而，在下降之前的前3个月，分枝杆菌病和巨细胞病毒（CMV）病的发病率仍然很高。HAART治疗6个月后CD4细胞计数达到200个/微升是随后机会性感染低风险的一个有价值指标。机会性感染的不同临床表现可能归因于与HAART免疫重建相关的免疫致病机制。需要重新定义预防和维持治疗的建议，以考虑到接受HAART治疗患者机会性感染风险的降低。有强有力的数据支持停止对卡氏肺孢子虫肺炎、弓形虫脑炎和鸟分枝杆菌感染的初级预防。
