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Preventive Care for HIV-Positive Adults-Reply

Frederick M. Hecht, MD; John Jewett, MD, MPH
JAMA. 1993;270(5):577. doi:10.1001/jama.1993.03510050043017.
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In Reply.  —Drs Olson, Wallace, Weiss, and Kennedy argue that annual testing of Toxoplasma IgG titers in HIV-infected patients is unnecessary. We agree that the low rate of Toxoplasma seroconversion documented in their recent study suggests that annual testing, which we mentioned in our article, is probably unnecessary. We believe that it may still be useful to repeat testing in patients with negative titers once a patient's CD4 cell count is below 0.20×109/L, particularly in areas where exposure to toxoplasmosis may be more frequent than in the western United States where their study was performed. Prior to a CD4 cell count of 0.20×109/L, Toxoplasma encephalitis is unlikely.1 Thus, test results are unlikely to have an important role in patient management at earlier stages of HIV, further diminishing the value of serial testing.We believe Dr Bachman's suggestion that teaching patients to seek immediate medical evaluation


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