Opportunistic Infection Prophylaxis: Efficacy and Access

Dr N Kumarasamy, in his keynote address, mentioned standards prophylaxis regimens for TB, MAC, PCP, Toxoplasmosis, Cryptosporidium and Cryptococcal meningitis. He pointed out that preventative measures were more important than prophylaxis. These include promoting condom use, safe IV drug use, environmental and occupational exposure, pet- related exposure, food hygiene and water quality and travel-related exposure. TB in Thailand and Cryptococcus meningitis in Cambodia were discussed. In the TB program, the default rate was high, but integration of IPT into a care package for PLWHAs in a care centre decreased defaults over time. Cryptococcus neoformans was the most common cause of meningitis in Phnom Penh. Improved strategies are needed for early diagnosis, treatment and prevention. Pimjai Satasit (Thailand) reported on prophylaxis for a range of infections. Surprisingly those on prophylaxis showed a higher incidence of OIs than the control group and this difference was highly significant. But, as Greg Dore pointed out in the discussion, this was a retrospective study, uncontrolled and non-random. It is likely that those people receiving prophylaxis had a lower CD4 count and were on monotherapy.