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Notice to Readers: Draft of Guidelines for the Prevention of
Opportunistic Infections (OIs) in Persons Infected with Human Immunodeficiency Virus
The 2001 Guidelines for the Prevention of Opportunistic Infections (OIs) in
Persons Infected with Human Immunodeficiency
Virus are now available in draft form on the AIDS Treatment and Information Service website
(http://www.hivatis.org).
These guidelines, originally published in 1995 and revised in 1997 and 1999,
address prevention of 19 HIV-associated OIs, or groups of OIs, with regard to
preventing exposure to the infectious agent, preventing disease by chemoprophylaxis
or vaccination (primary prophylaxis), and preventing disease recurrence in
persons already treated for an OI (secondary prophylaxis). The guidelines
include recommendations for adults and children, with specific information on care
of pregnant women. As in earlier editions of the guidelines, recommendations are
rated using a system that indicates the strength of each recommendation and quality
of evidence supporting it.
The primary changes in the 2001 guidelines pertain to
discontinuing chemoprophylaxis in patients whose CD4+ lymphocyte counts have increased
in response to highly active antiretroviral therapy. Since the 1999 guidelines, new
or strengthened recommendations are offered concerning discontinuation of
primary prophylaxis against Pneumocystis
carinii pneumonia (PCP), toxoplasmic
encephalitis (TE), and disseminated Mycobacterium
avium complex (MAC) disease; and for discontinuation of secondary prophylaxis against PCP, cytomegalovirus
retinitis, disseminated MAC, TE, and cryptococcal meningitis. Other changes include
new information on drug interactions and revised recommendations for vaccinating
HIV-exposed/infected children.
The 2001 guidelines were developed by representatives of U.S.
government agencies, professional organizations, academic institutions, and patient
advocacy groups after reviewing published manuscripts, abstracts, and material presented
at scientific meetings.
Comments on the guidelines may be addressed to Henry Masur,
M.D., <hmasur@nih.gov> and will be accepted until September 1, 2001. After this date,
the document will be revised and finalized. The guidelines are expected to be
updated periodically as new information becomes available.
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