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Preventive Care for HIV-Positive Adults

Patrick E. Olson, MD; Mark R. Wallace, MD; Peter J. Weiss, MD; Charles A. Kennedy, MD
JAMA. 1993;270(5):577. doi:10.1001/jama.1993.03510050043015.
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To the Editor.  —Drs Jewett and Hecht1 provide an excellent review of preventive health care measures for adults with human immunodeficiency virus (HIV) infection. We would like to make two points regarding the article.While baseline Toxoplasma IgG is a necessary part of serological evaluation of the HI V-infected adult, we do not believe that serial testing on an annual basis is justified. Our data2 showed that the annual incidence of Toxoplasma seroconversion in an HIV-infected US population was only 0.9%. This is similar to the 0.6% annual incidence noted in HIV-seronegative pregnant women in Oregon.3 Because Toxoplasma antibody level determination is expensive ($56.50; SmithKline Beecham Clinical Laboratories, San Diego, Calif), deleting annual serological testing could potentially save millions of dollars.Jewett and Hecht cite several reasons for the superiority of the percentage of CD4 cells over absolute CD4 cell count as a predictor of disease progression.


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