USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus: A Summary

Preface

In the United States, opportunistic infections reduce the quality and duration of life for approximately 1 million persons who have HIV infection [1], especially for the estimated 250,000 persons who are severely immunosuppressed, as measured by a CD4+ T-lymphocyte count below 200 cells/µL (2; Centers for Disease Control [CDC], unpublished data). In the late 1980s and early 1990s, efforts to prevent opportunistic infections focused first on chemoprophylaxis against Pneumocystis carinii pneumonia (PCP) [3, 4], and then on chemoprophylaxis against disseminated Mycobacterium avium complex (MAC) disease [5].

During the past decade, clinicians and researchers have learned that, in addition to P. carinii and MAC, other pathogens can cause disease in patients with HIV infection. Knowledge regarding the reduction of risk of exposure to, and thus acquisition of, opportunistic pathogens also has increased. During this decade, the number of chemoprophylactic regimens available for preventing disease also has increased. Information about preventing exposure and preventing disease is often published in journals that are not regularly reviewed by health-care providers; some of it has not yet been published.

In 1994, the U.S. Public Health Service (USPHS)—primarily through the efforts of CDC and the National Institutes of Health (NIH) and the Infectious Diseases Society of America (IDSA)—recognized the importance of preventing opportunistic infections and the need to consolidate information for health-care providers. In response, these organizations initiated an effort to develop comprehensive recommendations for the prevention of opportunistic infections in HIV-infected persons. Draft recommendations were reviewed by consultants from CDC, NIH, and IDSA, as well as by members of other Federal and non-Federal agencies, community organizations, physicians caring for HIV-infected persons, and HIV-infected persons themselves. These recommendations were discussed at a 2-day meeting convened by CDC, NIH, and IDSA in Atlanta in September 1994. Comments were solicited from the public, and …