Prophylactic Pharmacotherapy for HIV-related Opportunistic Infections

Introduction

Individuals with HIV are at higher risk of developing opportunistic infections due to compromised immunity. Prophylactic pharmacotherapy helps prevent bacterial infections such as Tuberculosis (TB) and Mycobacterium avium complex (MAC).

Common Prophylactic Drugs

For Tuberculosis (TB)

• Isoniazid (INH) - Used in combination with pyridoxine (Vitamin B6) to prevent TB in HIV patients.
• Rifabutin - Alternative to rifampin for TB prophylaxis, especially in individuals undergoing antiretroviral therapy.

For Mycobacterium avium complex (MAC)

• Azithromycin - Weekly dosing effectively prevents MAC infections in advanced HIV cases.
• Clarithromycin - Another effective alternative used in MAC prophylaxis.

Mechanism of Action

These antibiotics inhibit bacterial growth by targeting specific pathways essential for microbial survival. Isoniazid inhibits mycolic acid synthesis, rifabutin blocks RNA transcription, and macrolides interfere with protein synthesis.

Considerations and Side Effects

While prophylactic therapy is critical, careful monitoring for drug interactions and adverse effects is necessary:

• Isoniazid: Hepatotoxicity and neuropathy.
• Rifabutin: GI disturbances and uveitis.
• Azithromycin & Clarithromycin: QT prolongation and gastrointestinal upset.

Conclusion

Preventing opportunistic infections in HIV patients is essential for improving quality of life. Prophylactic pharmacotherapy plays a pivotal role in reducing disease burden and hospitalizations.