Treatment and prophylaxis of invasive pulmonary fungal infections in patients with AIDS

Abstract

Opportunistic infections continue to be important causes of morbidity and mortality in human immunodeficiency virus (HIV)-infected patients, although antiretroviral therapy decreases the incidence of these infections. In order to decrease the morbidity and mortality due to these infections, prophylaxis should be applied in addition to early diagnosis and treatment. Primary and/or secondary prophylaxis is suggested against fungal infections commonly seen in HIV-infected patients. Prophylaxis against Pneumocystis carini pneumonia prolongs patient's survival duration, decreases morbidity, and delays the progression of HIV disease. Because of the risk of dissemination, cryptococcal pneumonia should always be treated properly and secondary prophylaxis should be applied. Secondary prophylaxis is suggested also to patients who completed the initial treatment of coccidiodomycosis and histoplasmosis. In case of candidal infections progressing with frequent and severe recurrences, fluconazole can be used.