Antimicrobial therapy for the treatment of opportunistic infections in HIV/AIDS patients: a critical appraisal

Abstract

The widespread use of antiretroviral therapy (ART) has entirely changed the management of human immunodeficiency virus (HIV) infection and dramatically reduced the rates of opportunistic infections (OI). However, OI continue to cause significant morbidity and mortality in both developed countries, where presentation with advanced HIV infection is common, and also in developing countries where ART is less widely available. Evidence to direct OI guidelines is partly limited by the fact that many large-scale studies date from the pre-ART era and more recent studies are sometimes poorly powered due to the falling rates of OI. Treatment of OI is now known to be as much about antimicrobials as about immune reconstitution with ART, and recent studies help guide the timing of initiation of ART in different infections. OI have also become complicated by the immune reconstitution inflammatory syndrome phenomenon which may occur once successful immune recovery begins. Trimethoprim-sulfamethoxazole has long been one of the most important antibiotics in the treatment and prevention of OI and remains paramount. It has a broad spectrum of activity against Pneumocystis jiroveci, toxoplasmosis, and bacterial infections and has an important role to play in preventing life-threatening OI. New advances in treating OI are coming from a variety of quarters: in cytomegalovirus eye disease, the use of oral rather than intravenous drugs is changing the face of therapy; in cryptococcal meningitis, improved drug formulations and combination therapy is improving clearance rates and reducing drug toxicities; and in gut disease, the possibility of rapid immune restitution with ART is replacing the need for antimicrobials against cryptosporidia and microsporidia.

Encephalitozoon cuniculi Genotype III Evinces a Resistance to Albendazole Treatment in both Immunodeficient and Immunocompetent Mice

“…However, our data showed a simultaneous microsporidial spore number increase in organs outside the gastrointestinal tract, which is in accordance with results reported from previous studies, where the application of antimicrosporidial drugs or of potentially effective selected plant extracts led to a considerable shift of infection toward organs outside the gastrointestinal tract (10,11,24,43), causing misleading disappearances of microsporidia from the gastrointestinal tract and reductions in spore shedding despite their survival in multiple organs. Similarly, immune reconstitution with antiretroviral therapies in humans greatly reduced the occurrence of microsporidiosis-associated clinical symptoms in persons with HIV infection (44,45), but, for obvious reasons, we can only speculate about the suggested possibility of drifting of microsporidia between the gastrointestinal tract and visceral organs.…”

Socio-Behavioral Risk Factors Associated with Cryptosporidiosis in HIV/AIDS Patients Visiting the HIV Referral Clinic at Cape Coast Teaching Hospital, Ghana

“…Gastroenteritis triggered by Cryptosporidium infection causes prolonged or chronic diarrhea which leads to malnutrition and wasting, a life-threatening condition in HIV/AIDS infections [ 27 , 30 , 31 ]. A substantial number of chronic diarrhea in HIV infection is as a result of cryptosporidiosis, however, it still remains a major challenge in HIV/AIDS clinical management due to late diagnosis [ 32 ]. The delay in diagnosis and treatment of cryptosporidiosis arises due to multiple causative agents of chronic diarrhea in HIV infections [ 33 ].…”

Prevalence of opportunistic infections in HIV-positive patients in Bahrain: a four-year review (2009-2013)

“…CD4 count can indicate the stage of HIV disease, guide treatment, and predict the disease progression and prognosis. It can help to guide decisions to use OI prophylaxis and antiretroviral therapy [10].…”