Volume 1, Number 3—July 1995
News and Notes
USPHS and IDSA Collaborate on Guidelines to Prevent Opportunistic Infections in HIV-Infected Persons
U.S. Public Health Service (USPHS)/Infectious Diseases Society of America (IDSA) Guidelines for Preventing Opportunistic Infections in HIV-Infected Persons will be published in an August 1995 supplement of Clinical Infectious Diseases. The guidelines, which are intended for health care providers, are the result of collaboration between the Centers for Disease Control and Prevention (CDC), the National Institutes of Health, IDSA, numerous federal and nonfederal organizations, community groups, and HIV-infected persons. The guidelines are endorsed by the American Academy of Pediatrics, the Infectious Diseases Society of Obstetrics and Gynecology, and the Society of Healthcare Epidemiologists of America. Jonathan E. Kaplan, M.D. (CDC), Henry Masur, M.D. (NIH), and King Holmes, M.D., Ph.D. (University of Washington), chaired the USPHS/IDSA Prevention of Opportunistic Infections Working Group and are guest editors of the Clinical Infectious Diseases supplement.
CDC initiated work on the guidelines in early 1994; meetings were held in Atlanta in June and September to discuss and refine the recommendations.
The USPHS/IDSA guidelines address 17 opportunistic infections from three angles: 1) preventing exposure to opportunistic pathogens (e.g., sexual, occupational, and environmental exposure as well as exposure through pets, food, water, and international travel); 2) preventing opportunistic disease by chemoprophylaxis and vaccination; and 3) preventing disease recurrence. In this document, new recommendations were made and earlier recommenda- tions were updated. For example, new guidelines recommend that in nonemergency situations, cyto-megalovirus (CMV)-seronegative HIV-infected persons who require blood transfusions receive only CMV-antibody-negative or leukocyte-reduced cellular blood products. The guidelines also recommend that Toxoplasma-seropositive HIV-infected persons who have a CD4+ lymphocyte count <100 cells/µL received chemoprophylaxis against toxoplasmosis (such chemoprophylaxis is generally accomplished with anti-Pneumocystis carinii medication). Earlier recommendations for chemoprophylaxis against Pneumocystis carinii pneumonia and Mycobacterium avium complex disease have also been updated.
In addition to disease-specific recommendations, the guidelines include an overview article designed to prioritize the recommendations for health care providers. This article provides an approach to the initial and follow-up evaluations of the HIV-infected patient and also contains sections on HIV-infected pregnant women and HIV-exposed/infected children. The guidelines are followed by 15 background articles, which provide the information on which the recommendations were based and include research priorities generated by the development of the prevention recommendations.
The guidelines conclude with quality standards and implementation steps on the most standard-of-care recommendations, such as chemoprophylaxis against Pneumocystis carinii pneumonia. This final section provides a mechanism by which health care facilities can assess their degree of compliance with the recommendations, so that they can detect and correct compliance-related problems.
An abbreviated version of the USPHS/IDSA Guidelines will be published in CDC's Morbidity and Mortality Weekly Report in July.