1997 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus

PREFACE

In 1994, the U.S. Public Health Service (USPHS) and the Infectious Diseases Society of America (IDSA) recognized that, although strategies were available to reduce the frequency of opportunistic infections in patients who have human immunodeficiency virus (HIV) infection, information regarding prevention of both exposure and disease often was published in journals not regularly reviewed by health-care providers. In response, USPHS/IDSA developed comprehensive guidelines for health-care providers and patients that consolidated information pertaining to the prevention of opportunistic infections in persons infected with HIV. The resulting USPHS/IDSA guidelines were published in 1995 in MMWR, Clinical Infectious Diseases, and Annals of Internal Medicine, with an accompanying editorial in the Journal of the American Medical Association [1-4]. The response to the 1995 guidelines (e.g., the many requests for reprints and observations from health-care providers) suggests that they have served as a valuable reference against which local policies regarding prevention of opportunistic infections could be compared. Because recommendations were rated on the basis of the strength of the evidence supporting them, readers were able to assess for themselves to which areas adherence was most important [5].

In the United States, opportunistic infections continue to produce morbidity and mortality among the estimated 650 000-900 000 persons who are infected with HIV, especially among the estimated 200 000-250 000 persons who are severely immunosuppressed (i.e., persons who have a CD4⁺ T-lymphocyte count of <200 cells/µL) [6-10]. However, surveillance data indicate that the incidence of opportunistic infections has been changing in the United States. In HIV-infected men who have sex with men, Pneumocystis carinii pneumonia (PCP), toxoplasmic encephalitis, fungal infections, and disseminated Mycobacterium avium complex (MAC) disease have decreased in incidence [9]. Prophylactic regimens against opportunistic pathogens and more potent antiretroviral drugs appear to be important factors influencing this decline in …