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May 21, 1997

Physicians Face New Contradictions in HIV Care

JAMA. 1997;277(19):1504-1505. doi:10.1001/jama.1997.03540430016005

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THE LIFE-EXTENDING properties of protease inhibitors have created a clinical paradox for physicians treating patients infected with the human immunodeficiency virus (HIV).

Many patients who are taking combination therapy that includes a protease inhibitor are experiencing fewer opportunistic infections (OIs), even if they don't have a substantial increase in CD4 T cells. At the same time, however, physicians are diagnosing new OIs in patients who have had more marked increases in CD4 cell counts.

"We're seeing 2 seemingly contradictory things," Lisa Capaldini, MD, said during the 9th National AIDS Update Conference in San Francisco, Calif. "People with low T cells are getting these infections a lot less. But people who have gone from very low to higher T cells still seem to be at some risk."

So where does that leave physicians who must help their patients decide on prophylaxis for OIs? Capaldini, an internist in private practice in San