OPPORTUNISTIC INFECTIONS IN PATIENTS WITH AIDS - TREATMENT AND PROPHYLAXIS

Patients with AIDS are at increased risk for opportunistic infections, most notably Pneumocystis carinii pneumonia (PCP), cerebral toxoplasm osis, Mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinit is, and cryptococcal meningitis, Trimethoprim plus sulfamethoxazole is first-line therapy for both treatment and prophylaxis of PCP, and it provides partial protection against cerebral toxoplasmosis, For treatm ent of toxoplasmosis, pyrimethamine plus sulfadiazine is the top choic e, Against MAC, clarithromycin combined with at least one other agent (usually ethambutol) is recommended for treatment; rifabutin, clarithr omycin, or azithromycin may be used for prophylaxis. Therapy for CMV r etinitis focuses on using a ganciclovir-containing implant plus oral g anciclovir, the top choice to prevent systemic CMV disease, For crypto coccal meningitis, high-dose amphotericin B plus flucytosine is the mo st effective initial treatment; fluconazole is useful for lifelong mai ntenance therapy.