Prophylaxis for opportunistic infections in an era of effective antiretroviral therapy

Potent antiretroviral treatment is associated with dramatic improvements in immune function in many human immunodeficiency virus-infected patients. Th is has led to new US Public Health Service/Infectious Diseases Society of A merica guidelines that suggest that in certain circumstances (primary proph ylaxis for Pneumocystis carinii pneumonia and disseminated Mycobacterium av ium complex infection, and secondary prophylaxis for cytomegalovirus retini tis), antimicrobial prophylaxis can be discontinued for patients whose CD4 T-cell counts rise above threshold levels for at least 3-6 months. The new guidelines are probably too conservative, and effective antiretroviral trea tment almost certainly provides protection against all major opportunistic pathogens. Therefore, in the future, specific prophylaxis will be needed on ly for those patients who do not benefit from or fail to adhere to the curr ent more effective treatment of human immunodeficiency virus infection.