OPPORTUNISTIC INFECTIONS OCCURRING DURING HIGHLY-ACTIVE ANTIRETROVIRAL TREATMENT

Objective: To analyse the characteristics of opportunistic infections in patients receiving highly active antiretroviral treatment (HAART). Design and methods: A retrospective study performed in seven hospitals , included all patients starting treatment by ritonavir or indinavir b etween 26 March and 31 December 1996. Patients were evaluated for the development of AIDS-defining events. Clinical evaluation, plasma HIV-1 RNA quantification, CD4 cell count were recorded at baseline and at t he onset of the event. Results: Four hundred and eighty-six patients w ere included: 44.2% had a CD4 cell count below 50 x 10(6) cells/l. Fif ty clinical events were recorded in 46 patients with a mean follow-up of 6.1 months, of which 34 events (68%) were observed during the first 2 months of HAART. Eighteen of these occurred despite a reduction of vital load by at least 1.5 log(10) and a 100% increase of the CD4 cell count compared with that at the onset of the event, corresponding to 11 cytomegalovirus us infections, five mycobacterial infections, one c ase of cryptococcosis, and one case of Varicella-Zoster virus-related acute retinal necrosis. Among the 16 events observed after the second month, six occurred despite a marked biological improvement, correspon ding to a recurrence in five of six patients who had stopped their mai ntenance therapy. Events were one cytomegalovirus infection, two mycob acterial infections, one episode of oesophageal candidiasis and one cr yptococcal meningitis. Conclusion: In patients at high risk of develop ing an opportunistic infection prior to the institution of a HAART reg imen, prophylaxis should not be discontinued during the first 2 months of treatment, and maintenance therapy should be carried on despite a significant increase in the CD4 cell count. (C) 1998 Lippincott Willia ms & Wilkins.