Hospital Practice

ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage: http://www.tandfonline.com/loi/ihop20

Current Status of HIV Therapy: II. Opportunistic Diseases Judith Feinberg & Daniel F. Hoth Jr. To cite this article: Judith Feinberg & Daniel F. Hoth Jr. (1991) Current Status of HIV Therapy: II. Opportunistic Diseases, Hospital Practice, 26:3, 105-113, DOI: 10.1080/21548331.1991.11707716 To link to this article: http://dx.doi.org/10.1080/21548331.1991.11707716

Published online: 06 Jul 2016.

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Date: 18 August 2017, At: 19:22

AIDS: Problems and Prospects IV

Current Status of HIV Therapy: II. Opportunistic Diseases and DANIEL F. HOTH, JR Johns Hopkins Untverstty and Nattonallnstttute qf Allergy and Infectious Diseases

Downloaded by [Australian Catholic University] at 19:22 18 August 2017

JUDITH FEINBERG

Infections and malignancies account for most deaths in patients with AIDs-and will continue to do so as long as HIV-induced immunosuppression is progressive and irreversible. Options available for prevention and improved management of such diseases are changing as new agents emerge, new combinations of agents are developed, and new indications for available agents are identified.

Acquired immune deficiency syndrome is characterized by infection with a wide variety of viruses, bacteria. fungi, and parasites and by the occurrence of certain malignancies. About 90% of deaths in patients infected with human immunodeficiency virus are directly or indirectly attrtbutable to such opportunistic diseases. Antiretroviral therapy prolongs survival in patients with AIDS, but it cannot reverse HIV-induced immunosuppression. In that context. the management and prevention of opportunistic diseases promises to become an even more pressing problem (Ftgure 1). Many of the opportunistic diseases in AIDS are famlliar because they occur in other immunocompromised patients, and even in some immunocompetent persons. Management in such cases often differs from that for AIDS patients, however. Medically induced immunosuppression, as in transplant recipients, can sometimes be moderated whUe the infection is brought under control. Because such immunosuppression is usually temporary, recovery from infection is possible. In AIDS, immunosuppression progresses inexorably, although it may be stabllized for a time with antiretroviral therapy. Thus, initial control of an infection may be more difficult and often must be followed by lifelong maintenance therapy, since the infection is suppressed rather than eradicated. Opportunistic diseases in AIDS patients may

also require a different therapeutic approach because of differing pathophysiology. For example, cytomegalovirus tends to cause pneumonia in transplant recipients but retinitis in AIDS patients. Finally, AIDS patients do not tolerate medications as well as other patients do and may have more severe or more frequent toxic reactions. In the United States, much of the clinical research on opportunistic diseases is being carried out by the AIDS Clinical Trials Group (ACTG), which comprises investigators from 4 7 medical centers and operates under the auspices of the Division of AIDS of the NlAID. The ACTG's research strategy for opportunistic disease is multipronged. One goal is to make more agents or combinations available (which may include expanding the indications for agents currently marketed). Another is to replace agents that require frequent intravenous dosing with oral or parenteral agents that have long half-lives. The ultimate goal is to prevent opportunistic illness Or. Feinberg. formerly Opportunistic Infections Section Head. Treatment Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda. is r.ow Assislant Professor. Department of Medicine, Division of lniectious Diseases. Johns Hopkins University School of Medicine. Baltimore. Dr. Hoth is Director, Division of AIDS. NIAID. Part I nf this article, "Antiretroviral Agents ... by Drs. Hoth and Maureen W. Myers, appeared in the Janu

Current status of HIV therapy: II. Opportunistic diseases.

Infections and malignancies account for most deaths in patients with AIDS--and will continue to do so as long as HIV-induced immunosuppression is prog...
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