Reducing the Impact of Opportunistic Infections in Patients With HIV Infection

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Abstract
As many as 1 million individuals in the United States are infected with the human immunodeficiency virus (HIV).1For these persons, and especially for the approximately 250 000 who have severe immunosuppression as measured by a CD4+lymphocyte count below 0.20×109/L (200/μL) (includes persons with [T. Green, PhD, Centers for Disease Control and Prevention (CDC), unpublished results, 1994] and without2AIDS-defining illnesses) opportunistic infections exact a heavy toll in terms of quality and length of life. Among patients with severe immunosuppression, the cumulative risk of serious opportunistic infection has been estimated to be 33% after 1 year and 58% after 2 years.3In addition to the morbidity and mortality associated with these opportunistic infections, treatment of these illnesses costs billions of dollars annually. The last 5 years have witnessed a gratifying surge in our knowledge of the environmental sources of opportunistic pathogens, ways to reduce