Epidemiology and Risk Factors

Table 18-4 shows the relationship between opportunistic infections (OIs) and specific levels of immunocompromise as measured by CD4+ lymphocyte counts; 200 cells^L is a critical threshold for prophylactic treatment (Clumeck and Wit, 2003). More than half of HIV patients with CD4+ counts below this level experience an AIDS-related OI in 2 years.

Human cases of Pneumocystis carinii pneumonia (PCP) are now understood to be caused by Pneumocystis jiroveci. Most healthy children have been infected asymptomatically with P jiroveci by age 4 years (Pifer et al., 1978), allowing cases in HIV patients to occur either by reactivation or by new exposure. Without antiretroviral therapy or PCP prophylaxis, more than 70% of HIV-infected patients could be expected to experience PCP, with 20% to 40% mortality (Phair et al., 1990).

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