THE PAST 30 years have seen unprecedented growth in the numbers of immunosuppressed patients, with iatrogenic and disease-related immunosuppression. Approximately 100 000 US citizens undergo long-term immunosuppression to preserve life-sustaining solid organ allografts. Worldwide, 36.1 million people are estimated to be living with the human immunodeficiency virus (HIV) or the acquired immunodeficiency syndrome. Chronic lymphocytic leukemia (CLL) affects approximately 81 000 patients per year in the United States, resulting in a prolonged immunocompromised status. To a lesser degree, patients with inflammatory disorders of the cutaneous and musculoskeletal systems may undergo long-term immunosuppression with therapeutic medications. Finally, we are entering an era of exploration in the use of biologic response modifiers and antibody-mediated immunomodulation with unknown long-term effects.
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