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Reducing the Impact of Opportunistic Infections in Patients With HIV Infection: Title and subTitle BreakNew Guidelines FREE

Jonathan E. Kaplan, MD; Henry Masur, MD; Harold W. Jaffe, MD; King K. Holmes, MD, PhD
[+] Author Affiliations

Reprint requests to Division of HIV/AIDS Prevention, Mailstop G-29, Centers for Disease Control and Prevention, Atlanta, GA 30333 (Dr Kaplan).


JAMA. 1995;274(4):347-348. doi:10.1001/jama.1995.03530040075045
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As many as 1 million individuals in the United States are infected with the human immunodeficiency virus (HIV).1 For these persons, and especially for the approximately 250 000 who have severe immunosuppression as measured by a CD4+ lymphocyte count below 0.20×109/L (200/μL) (includes persons with [T. Green, PhD, Centers for Disease Control and Prevention (CDC), unpublished results, 1994] and without2 AIDS-defining illnesses) opportunistic infections exact a heavy toll in terms of quality and length of life. Among patients with severe immunosuppression, the cumulative risk of serious opportunistic infection has been estimated to be 33% after 1 year and 58% after 2 years.3 In addition to the morbidity and mortality associated with these opportunistic infections, treatment of these illnesses costs billions of dollars annually.

The last 5 years have witnessed a gratifying surge in our knowledge of the environmental sources of opportunistic pathogens, ways to reduce

REFERENCES

Centers for Disease Control and Prevention.  Estimates of HIV prevalence and projected AIDS cases: summary of a workshop, October 31-November 1, 1989. MMWR Morb Mortal Wkly Rep . 1990;;39:110-112, 117-119.
Centers for Disease Control and Prevention.  Projections of the number of persons diagnosed with AIDS and the number of immunosuppressed HIV-infected persons— United States, 1992-1994. MMWR Morb Mortal Wkly Rep . 1992;;41(No. (RR-18) ):1-29.
Kaplan JE, Masur H, Holmes KK, et al.  USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: introduction. Clin Infect Dis . 1995;;21( (suppl 1) ):S1-S11.
Kaplan JE, Masur H, Holmes KK, et al.  USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: an overview. Clin Infect Dis . 1995;;21( (suppl 1) ):S12-S31.
USPHS/IDSA Prevention of Opportunistic Infections Working Group.  USPHS/ IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: disease-specific recommendations. Clin Infect Dis . 1995;;21( (suppl 1) ):S32-S43.
Centers for Disease Control and Prevention.  USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: a summary. MMWR Morb Mortal Wkly Rep . July 14, 1995;;44( (RR-8) ).
Centers for Disease Control.  Guidelines for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus. MMWR Morb Mortal Wkly Rep . 1989;;38( (suppl 5) ):1-9.
Centers for Disease Control.  Recommendations for prophylaxis against Pneumocystis carinii pneumonia for adults and adolescents infected with human immunodeficiency virus. MMWR Morb Mortal Wkly Rep . 1992;;41(No. (RR-4) ):1-11.
Centers for Disease Control.  Diagnosis and management of mycobacterial infection and disease in persons with human immunodeficiency virus infection. Ann Intern Med . 1987;;106:254-256.
Centers for Disease Control.  Purified protein derivative (PPD)-tuberculin anergy and HIV infection: guidelines for anergy testing and management of anergic persons at risk of tuberculosis. MMWR Morb Mortal Wkly Rep . 1991;;40(No. (RR-5) ):27-33.
Masur H, Public Health Service Task Force on Prophylaxis and Therapy for Mycobacterium avium Complex.  Recommendations on prophylaxis and therapy for disseminated Mycobacterium avium complex disease in patients infected with the human immunodeficiency virus. N Engl J Med . 1993;;329:898-904.
Small PM, Shafer RW, Hopewell PC, et al.  Exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis in patients with advanced HIV infection. N Engl J Med . 1993;;328:1137-1144.

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Centers for Disease Control and Prevention.  Estimates of HIV prevalence and projected AIDS cases: summary of a workshop, October 31-November 1, 1989. MMWR Morb Mortal Wkly Rep . 1990;;39:110-112, 117-119.
Centers for Disease Control and Prevention.  Projections of the number of persons diagnosed with AIDS and the number of immunosuppressed HIV-infected persons— United States, 1992-1994. MMWR Morb Mortal Wkly Rep . 1992;;41(No. (RR-18) ):1-29.
Kaplan JE, Masur H, Holmes KK, et al.  USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: introduction. Clin Infect Dis . 1995;;21( (suppl 1) ):S1-S11.
Kaplan JE, Masur H, Holmes KK, et al.  USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: an overview. Clin Infect Dis . 1995;;21( (suppl 1) ):S12-S31.
USPHS/IDSA Prevention of Opportunistic Infections Working Group.  USPHS/ IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: disease-specific recommendations. Clin Infect Dis . 1995;;21( (suppl 1) ):S32-S43.
Centers for Disease Control and Prevention.  USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: a summary. MMWR Morb Mortal Wkly Rep . July 14, 1995;;44( (RR-8) ).
Centers for Disease Control.  Guidelines for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus. MMWR Morb Mortal Wkly Rep . 1989;;38( (suppl 5) ):1-9.
Centers for Disease Control.  Recommendations for prophylaxis against Pneumocystis carinii pneumonia for adults and adolescents infected with human immunodeficiency virus. MMWR Morb Mortal Wkly Rep . 1992;;41(No. (RR-4) ):1-11.
Centers for Disease Control.  Diagnosis and management of mycobacterial infection and disease in persons with human immunodeficiency virus infection. Ann Intern Med . 1987;;106:254-256.
Centers for Disease Control.  Purified protein derivative (PPD)-tuberculin anergy and HIV infection: guidelines for anergy testing and management of anergic persons at risk of tuberculosis. MMWR Morb Mortal Wkly Rep . 1991;;40(No. (RR-5) ):27-33.
Masur H, Public Health Service Task Force on Prophylaxis and Therapy for Mycobacterium avium Complex.  Recommendations on prophylaxis and therapy for disseminated Mycobacterium avium complex disease in patients infected with the human immunodeficiency virus. N Engl J Med . 1993;;329:898-904.
Small PM, Shafer RW, Hopewell PC, et al.  Exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis in patients with advanced HIV infection. N Engl J Med . 1993;;328:1137-1144.
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