Opportunistic infections shortly after beginning highly active antiretroviral therapy

The clinical benefit of highly active antiretroviral therapy (HAART) has be en attributed to its suppression of viral replication and improvement in th e CD4 lymphocyte count. However, the development of clinical symptoms secon dary to previously silent opportunistic pathogens shortly after beginning H AART has been reported as a distinct clinical syndrome and seems to be asso ciated with inflammatory phenomena surrounding a rapid restoration of the i mmune system in previously immunosuppressed patients. Herein, we report nin e (3.6%) episodes of opportunistic infections (01) in 247 human immunodefic iency virus (HIV)-infected patients undergoing HAART in a reference HIV/AID S institution located in Madrid, Spain. In all instances, 01 clustered with in the first 3 months after beginning HAART Episodes of cerebral toxoplasmo sis (three cases), Pneumocystis carinii pneumonia (two eases), and herpes t ester (two cases) occurred in persons without a previous AIDS-defining illn ess, in addition a relapse of cytomegalovirus retinitis and a rebound in Ka posi's sarcoma were seen, respectively. in another two patients. Four of th e nine subjects had a CD4 count above 200 cells/mm(3) before HAART began. O f these, one developed Pneumocystis pneumonia and one other cerebral toxopl asmosis. In conclusion, prophylaxis and close clinical monitoring of HIV-in fected patients should be considered for the first 3 months after beginning HAART, even for subjects without severe immunosuppression.