Opportunistic infections in HIV disease: Down but not out

Widespread use of combination antiretroviral therapy consisting of at least three active agents has completely transformed the management of HIV disea se. Since 1996 when this therapy was introduced, there has been a dramatic decline in the incidence of AIDS-related opportunistic infections such as P neumocystis carinii pneumonia, disseminated Mycobacterium avium complex, an d invasive cytomegalovirus disease. Despite this decline, however, opportun istic infections continue to occur, especially in patients who are unaware that they are HIV infected and those who are prescribed antiviral therapy a nd do not take it. This article takes a symptom-based approach to the prese ntation, diagnosis, and treatment of HIV-related opportunistic infections a s they occur in the current antiviral era.