PREVENTION AND TREATMENT OF OPPORTUNISTIC INFECTIONS

Effective and well-tolerated therapies for treatment and prophylaxis of opportunistic infections in the acquired immunodeficiency syndrome were reported during the past year. Atovaquone and trimetrexate were somewhat less efficacious but also less toxic than trimethoprim-sulfamethoxazole for mild and severe Pneumocystis carinii pneumonia, respectively. Trimethoprim-sulfamethoxazole was superior to aerosol pentamidine for prophylaxis of P. carinii pneumonia. Itraconazole was effective for mild-to-moderate episodes of disseminated histoplasmosis. Fluconazole and relatively low-dose amphotericin were only modestly effective for cryptococcal meningitis, but fluconazole was highly efficacious in preventing relapse of cryptococcal meningitis. For Toxoplasma gondii encephalitis, clindamycin was effective in combination with pyrimethamine. Trimethoprim-sulfamethoxazole was effective in prophylaxis of toxoplasmosis in a retrospective study. Foscarnet provided a survival benefit over ganciclovir in the treatment of cytomegalovirus retinitis in one controlled investigation. Finally, strategies are being developed to provide broad-spectrum prophylaxis against the panorama of opportunistic infections affecting patients with acquired immunodeficiency syndrome.