Day one:
After you've tested positive

May 2008     View PDF     En español

Opportunistic infection strategy

Once the immune system has failed to a significant degree, it becomes necessary to try to prevent the most common OIs, or prevent them from coming back. OI prevention or prophylaxis should be considered when CD4 counts are in or nearing a danger zone. For example, the risk of getting PCP becomes high at CD counts of 300 or less. The risk of other infections, like CMV and MAC, increase dramatically when CD4 counts fall below 100.

The careful and timely use of medicine can prevent PCP altogether. As the rate of tuberculosis (TB) rises among HIV-positive people, testing and preventive treatment (if necessary) is recommended. Preventive treatment for other infections, including MAC and recurrent fungal infections, are available as well.

In advanced HIV disease, a person often must try to treat or prevent several OIs at the same time. This can lead to difficult choices, since many medicines can interact with each other. Two publications from Project Inform can help sort this out: Opportunistic Infections Chart and Strategies for Managing Opportunistic Infections.

The key to successful interventions is comprehensive inclusion — doing all of the things that make sense for you. The biggest mistake is to rigidly choose one approach over the others. HIV is not a political debate or a matter of opinion; it can be a life-threatening illness. Every decision you make about treatment has consequences, and each person has little room for mistakes. So it makes no sense to bet your life on any one philosophy of medicine.