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Discontinuing Prophylaxis against Recurrent Opportunistic Infections in HIV-Infected Persons: A Victory in the Era of HAART

Jonathan E. Kaplan, MD; Henry Masur, MD; and King K. Holmes, MD, PhD
[+] Article, Author, and Disclosure Information

Requests for Single Reprints: Jonathan E. Kaplan, MD, Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road, Atlanta, GA 30333.

Current Author Addresses: Dr. Kaplan: Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road, Atlanta, GA 30333.

Dr. Masur: National Institutes of Health, Department of Critical Care Medicine, Building 10, Room 7043, Bethesda, MD 20892.

Dr. Holmes: University of Washington, Center for AIDS and STD, 1001 Broadway, Suite 215, Seattle, WA 98122.

Ann Intern Med. 2002;137(4):285-287. doi:10.7326/0003-4819-137-4-200208200-00013
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The use of highly active antiretroviral therapy (HAART) has resulted in a remarkable decrease in morbidity and mortality among HIV-infected persons. The immune reconstitution resulting from successful use of HAART has raised the possibility that chemoprophylaxis against specific opportunistic infections—therapy that heretofore was considered required for life—might safely be discontinued. While several observational and randomized studies have provided strong support for this practice against first episodes of Pneumocystis carinii pneumonia, disseminated Mycobacterium avium complex (MAC) disease, and toxoplasmic encephalitis (13), data on discontinuation of prophylaxis after an episode of disease—so called “secondary prophylaxis” or chronic maintenance therapy—are sparse, except those for P. carinii pneumonia (4).

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