We thank Dr Perlman and associates for highlighting the risks of infectious diseases among HIV-infected injection drug users, a population that accounts for a substantial proportion of new HIV infections in the United States each year. Their letter raises 2 issues pertinent to the USPHS/ IDSA guidelines for prevention of opportunistic infections in persons infected with HIV.
The first concerns the focus of the guidelines. We have defined opportunistic infections as infections that occur with increased frequency, severity, or both in HIV-infected persons, presumably because of immunosuppression.1 Given the broad nature of issues related to the care of HIV-infected persons, we limited the scope of the guidelines in both 19952 and 19973 to the opportunistic infections of greatest importance in HIV-infected persons. This focus is apparent in the opportunistic infections addressed in the disease-specific recommendations as well as in the sections in both documents entitled "Prevention of
Kaplan JE, Jaffe HW, Masur H, Holmes KK. Preventing Opportunistic Infections in HIV-Infected Injection Drug Users-Reply. JAMA. 1997;278(21):1743-1744. doi:10.1001/jama.1997.03550210041034