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Preventive Care for HIV-Positive Adults

David M. Bachman, MD
JAMA. 1993;270(5):577. doi:10.1001/jama.1993.03510050043016.
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To the Editor.  —I am an ophthalmologist treating many patients with AIDS and cytomegalovirus (CMV) retinitis. In their excellent article entitled "Preventive Health Care for Adults With HIV Infection," Jewett and Hecht1 cite the many medications and methods that have prolonged and improved the lives of many patients with AIDS. Perhaps the worst fate to befall an AIDS patient is CMV retinitis, which will, if untreated, progress to total blindness. We do not yet have an adequate oral preventive drug for CMV retinitis or CMV infection elsewhere in the body. (Neither oral nor intravenous acyclovir prevents CMV infection.) Most internists feel that it is not fair to treat a patient prophylactically with 7 days intravenous ganciclovir or foscarnet, because both drugs require an indwelling venous catheter, with its attendant risk of bacteremia as well as being a great imposition on the patient. We do know, however, that only patients


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