Bacterial infections in adult HIV-infected patients.
OBJECTIVE
The purpose of this article is to critically review articles published from the pre-HAART era to the present on bacterial infections in adult HIV-infected patients.


METHODS
Literature search on bacterial infections in HIV-infected patients yields predominantly small case series from single centers, many of which are retrospectively collected.


RESULTS
Variations in case selection limit the utility of these articles for assessing the epidemiology and clinical features of a particular infection. Nonetheless, numerous articles indicate that certain bacterial infections occur most often when CD4 cell counts are < 200/mm3. In the pre-HAART era, others suggest that PcP prophylaxis with TMP/SMX and MAC prophylaxis with macrolides reduced rates of several bacterial infections. Since the advent of HAART, however, some articles suggest that the incidence of various infections has declined and that withdrawal of OI prophylaxis in patients who have had HAART restoration of CD4 cell counts has not led to an increase in certain bacterial infections.


CONCLUSIONS
This review suggests that bacterial infections may have declined in the HAART era, as multicenter cohort studies have shown to be the case with AIDS-associated OIs. Nonetheless, preventive measures such as pneumococcal vaccination and smoking cessation remain effective strategies.
Nagappan
Vijayalakshmi
V
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109-0378, USA.
Kazanjian
Powel
P
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001424:Bacterial Infections / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans