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John T. Brooks, Jonathan E. Kaplan, King K. Holmes, Constance Benson, Alice Pau, Henry Masur, HIV-Associated Opportunistic Infections—Going, Going, But Not Gone: The Continued Need for Prevention and Treatment Guidelines, Clinical Infectious Diseases, Volume 48, Issue 5, 1 March 2009, Pages 609–611, https://doi.org/10.1086/596756
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In the United States, the incidence of HIV-associated opportunistic infections (OIs) has decreased dramatically. The trend observed in the Centers for Disease Control and Prevention (CDC)-sponsored HIV Outpatient Study—a prospective, observational cohort study involving >8500 HIV-infected persons in 9 US cities who have received routine outpatient care (figure 1)—is typical of trends seen in many other clinical and research cohorts and medical practices. These reductions have resulted, in part, from improvements in and the diffusion of effective OI prophylaxis, but most importantly, they have resulted from the advent of combination antiretroviral therapy. It is not uncommon now for some medical residents and infectious diseases fellows to have never seen a case of cytomegalovirus retinitis or cryptosporidial diarrhea in an HIV-infected patient. As antiretroviral therapy becomes simpler, more potent, and less toxic, and as our clinical concerns focus increasingly on the growing number of non-HIV-associated complications of HIV infection, we might be falsely reassured that OIs are soon to become a thing of the past.
