Effectiveness of potent antiretroviral therapies on the incidence of opportunistic infections before and after AIDS diagnosis

Objectives: To determine the effectiveness of potent antiretroviral therapy in reducing opportunistic infections (OI) as both a presenting event and s ubsequent to an AIDS-defining event. Design and methods: A total of 543 seroconverters and 1470 men with AIDS we re compared for the time to development of OI as the presenting AIDS event and as a subsequent event in the 1984-1989, 1990-1992, 1993-1995, and 1996- 1998 periods, when the major treatments were no therapy, monotherapy, combi nation therapy, and potent antiretroviral therapy, respectively. Results: The seroconverters suffered 132 OI and the participants with AIDS had 717 OI. The relative hazard (RH) of OI as the presenting AIDS event dec lined by 81% in the calendar period when potent antiretroviral therapy was available compared with the monotherapy period. Declines were observed for Mycobacterium avium complex, cytomegalovirus disease, and esophageal candid iasis, but were statistically significant only for Pneumocystis carinii pne umonia. The RH of OI as a secondary infection dropped by 77% in the last ca lendar period compared with the monotherapy period. A significant decline w as observed for all four OI. Prophylactic drug use did not increase in the era of potent anti retroviral therapy. Conclusion: The hazard of OI in the era of potent antiretroviral therapy ha s declined dramatically compared with the era of monotherapy, despite the c oncurrent decrease in the use of prophylactic drugs. Physicians should cons ider whether it is necessary to include prophylactic drugs as part of the c omplex drug regimen for patients on potent antiretroviral therapy. (C) 2001 Lippincott Williams & Wilkins.