PREVENTING OPPORTUNISTIC INFECTIONS IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PERSONS - IMPLICATIONS FOR THE DEVELOPING-WORLD

More than 18 million persons in the world are estimated to have been i nfected with human immunodeficiency virus (HIV), the cause of the acqu ired immunodeficiency syndrome (AIDS). As immunodeficiency progresses, these persons become susceptible to a wide variety of opportunistic i nfections (OIs) The spectrum of OIs varies among regions of the world. Tuberculosis is the most common serious OI in sub-Saharan Africa and is also more common in Latin America and in Asia than in the United St ates. Bacterial and parasitic infections are prevalent in Africa; prot ozoal infections such as toxoplasmosis, cryptosporidiosis, and isospor iasis are also common in Latin America. Fungal infections, including c ryptococcosis and Penicillium marneffei infection, appear to be preval ent in Southeast Asia. Despite limited health resources in these regio ns, some measures that are recommended to prevent OIs in the United St ates may be useful for prolonging and improving the quality of life of HIV-infected persons. These include trimethoprim-sulfamethoxazole to prevent Pneumocystis carinii pneumonia, toxoplasmosis, and bacterial i nfections; isoniazid to prevent tuberculosis; and 23-valent pneumococc al vaccine to prevent disease due to Streptococcus pneumoniae. Researc h is needed to determine the spectrum of OIs and the efficacy of vario us prevention measures in resource-poor nations, and health officials need to determine a minimum standard of care for HIV-infected persons. An increasing problem in the developing world, HIV/AIDS should receiv e attention comparable to other tropical diseases.