Am Fam Physician. 1998 Feb 1;57(3):433.
to the editor: In our July 1997 article1 on opportunistic infections and psychosocial stress in persons with human immunodeficiency virus (HIV), Dr. Gebhardt and I described the current U.S. Public Health Service and the Infectious Disease Society of America (USPHC/IDSA) guidelines. Our article also mentioned that the new guidelines were soon to be forthcoming. The updated guidelines were recently published.2 The following are the most significant changes:
Prophylaxis for Mycobacterium avium complex (MAC) has moved from a B rating to an A (“standard of care”) rating. This means that, like prophylaxis for Pneumocystis carinii pneumonia, toxoplasmosis and Mycobacterium tuberculosis, MAC prophylaxis should always be offered when clinical and staging criteria are met.
Vaccination against Streptococcus pneumoniae in adults with a CD4+ count greater than 200 per mm3 (200 × 106 per L) has moved from a B rating to an A (“standard of care”) rating. Thus, all adults in this category should receive pneumococcal vaccine polyvalent (Pneumovax).
The USPHC/IDSA guidelines also now emphasize (as we did in our article) the need to base initiating or continuing prophylaxis on the lowest (not necessarily the current) CD4+ cell count.
1. Montauk SL, Gebhardt B. Opportunistic infections and psychosocial stress in HIV. Am Fam Physician. 1997;56:87–96.
2. USPHC/IDSA Prevention of Opportunistic Infections Working Group. 1997 USPHC/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. MMWR Morb Mortal Wkly Rep. 1997;46:1–46.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 1998 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions