Seattle Treatment Education Project: STEP Perspective - Volume 4,
Dr. Judith Feinberg from Johns Hopkins University was one of the
few clinical scientists to speak on the concept of multiple
opportunistic pathogen prophylactic strategies, or MOPPS. This
concept refers to individuals prophylaxing against numerous
opportunistic infections at the same time.
The concept of broad-spectrum prophylactic therapy for the most
common opportunistic infections in AIDS has recently been the
subject of discussion. Certainly, drug therapy to prevent active
infection seems an attractive option. As Dr. Feinberg said,
"Treatment is nice, but prophylaxis is better." The potential
success of MOPPS is based on the past success of pneumocystis
Any prophylactic drug regimen requires that it be effective, well-
tolerated, affordable, and have few interactions with other drugs
the patient may be taking. Issues concerning MOPPS include the
combination drugs which would be most effective, proper timing of
starting therapy, minimal effective dose and schedule of dosing,
and most importantly, the potential effect of MOPPS on drug
resistance in opportunistic infections.
In addition to pneumocystis prophylaxis, Dr. Feinberg offered some
therapeutic prospects to be considered for MOPPS regimens:
1. Clarithromycin, Azithromycin: partially effective against
MAC, toxoplasmosis, cryptosporidiosis, microsporidiosis, and some
2. Oral forms of gancyclovir, foscarnet, and acyclovir;
HPMPC, cyclobut-G: partially effective against cytomegalovirus,
herpes simplex virus, varicella-zoster virus (shingles).
3. Fluconazole, itraconazole: partially effective against
cryptococcus, histoplasmosis, candida, aspergillus.
The risks and benefits of MOPPS have not yet been clearly
defined. If a strategy such as this emerges as a valid therapy in
HIV infection, there must be clear plans for the management of
drug toxicity and drug resistance.