[Prevention of opportunistic infections in the protease inhibitor era]

From the middle of 1996 we are living a striking reduction of incidence of opportunistic infections (Ols) associated to human immunodeficiency virus (HIV). The recovery of the immune system, at least partially, is showing up substantial changes of Ols after the introduction of highly active antiretroviral therapy (HAART): relieves, sometime complete resolutions, of Ols that previously did not give any response to the treatment (cryptosporidiosis, microsporidiosis, progressive multifocal leucoencephalopathy and Kaposi's sarcoma), changes of clinical presentations after HAART (CMV retinitis [CMVR] with vitritis and Mycobacterium avium-intracellulare [MAC] lymphadenitis), related to exuberant inflammatory response; and at last, long periods without reactivation of the Ols after prophylaxis suppression (CMVR and Pneumocystis carinii pneumonia [PCN]). All this sep up the necessity of a change in the prophylaxis recommendations after HAART introduction. This change would have been unthinkable two years ago, the point is to answer the following question: when can Ols prophylaxis to be stopped after HAART? The progress in the therapy of HIV and Ols infections have happened that fast that this recommendations will have to be reconsidered continuously.