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From the Centers for Disease Control and Prevention
September 19, 2001

Draft of Guidelines for the Prevention of Opportunistic Infections (OIs) in Persons Infected With Human Immunodeficiency Virus

JAMA. 2001;286(11):1308. doi:10.1001/jama.286.11.1308-JWR0919-2-1

MMWR. 2001;50:687

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.