[Prevention of opportunistic infections in HIV-infected adults]

Opportunistic infections have a major influence on morbidity and mortality in HIV-infected individuals. Prophylactic measures have to be introduced for each patient, corresponding to the stage of disease measured by CD4-lymphocyte count. They consist of exposure prophylaxis, vaccinations and especially chemoprophylaxis with antimicrobials. Some live vaccines are contraindicated in HIV infected patients. Pneumococcal vaccine for every patient and specific primary prophylaxis against pneumocystis carinii pneumonitis, cerebral toxoplasmosis and M. avium infection in patients with manifest immunodeficiency improve survival and quality of life of many patients. After most opportunistic infections, secondary lifelong antimicrobial prophylaxis is indicated. In future, indications of primary and secondary prophylaxis have to be redefined in the light of the new antiretroviral combination therapies.