chapter  9
16 Pages

Treatment Issues in AIDS

A cquired im m une deficiency syndrom e (AIDS) presents one o f the m ost com plex therapeutic challenges o f any disease ever described. While fu n d a­ mentally a systemic viral infection, its hallm ark is a p rofound im m unodefi­ ciency that leaves the hum an host susceptible to many opportunistic infec­ tions (OIs) which eventually lead to death in most patients. T he most com m on A ID S-defining O I in the U nited States is pneum onia due to Pneumocystis carinii, an ubiquitous parasite that causes life-threatening pulm onary infec­ tion in the im m unocom prom ised host. O ther organism s causing OIs in pa­ tients with AIDS include cytom egalovirus (CMV), Mycobacterium avium intracellulare (MAI), Toxoplasma gondii, Cryptococccus neoformans, Candida albicans, and Cryptosporidium. In addition, individuals infected with the hum an im m u­ nodeficiency virus (HIV)* are at increased risk for developing malignancies, the most com mon by far being Kaposi’s sarcoma (KS). It is not understood why some H IV -infected individuals develop KS, often m onths or even years before developing their first m ajor opportunistic infection, while others are spared this manifestation o f the disease. Epidemiologic evidence suggests the role o f a cofactor, which may be particularly prevalent in the male hom o­ sexual population .1