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International AIDS Conference VIII: Multiple Opportunistic Pathogen Prophylactic Strategies (MOPPS)
Lori Panther, M.D.
March 10, 1992
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 prophylaxis.

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 bacteria.

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.