200. A Window of Opportunity: Preventing and Treating HIV Opportunistic Infections

HIV-mediated immunosuppression leaves patients vulnerable to opportunistic infections (OIs), necessitating a structured clinical approach based on CD4 counts and viral load. Management hinges on early identification of symptoms—ranging from respiratory distress in Pneumocystis pneumonia to neurological deficits in toxoplasmosis—and tailoring investigations to specific pathogen risks. Prophylaxis and treatment protocols, such as trimethoprim-sulfamethoxazole for PCP and toxoplasmosis or itraconazole for fungal infections, are critical for improving patient outcomes. Recent clinical data, including the IDEAL and A5164 studies, demonstrate that early initiation of antiretroviral therapy is safe and effective in the context of OIs. Clinicians must maintain a high index of suspicion, integrate patient history with endemic exposure risks, and coordinate closely with infectious disease specialists to navigate the complexities of diagnosis and the potential for immune reconstitution inflammatory syndrome.