Discontinuing Prophylaxis for Opportunistic Infection: Guiding Principles

Several large observational studies have documented the reduced risk of opportunistic infections among recipients of potent combination antiretroviral therapy. These data raise the question of whether subjects who respond to antiretroviral therapy need to continue prophylaxis for opportunistic infection. Factors to consider when deciding whether it is safe to discontinue prophylaxis include the following: (1) the risk of developing the specific opportunistic infection; (2) the consequences of the infection (morbidity and availability of effective therapy); (3) both the short-term and long-term toxicity of the agent used for prophylaxis; (4) the potential for drug interactions between the agent used for prophylaxis and other therapies for human immunodeficiency virus infection; (5) the psychological benefit of discontinuing a treatment during the course of a chronic disease; (6) the risk of development of drug resistance during prophylaxis; and (7) costs. This article reviews current data on predicting risk of opportunistic infection, the most critical of these factors.