For immediate release
September 10, 2001
Contact: Colleen Henrichsen , Warren Grant Magnuson Clinical Center Communications Office, (301) 496-2563
The US Public Health Service and Infectious Diseases Society of American have updated guidelines for prevention of HIV-related opportunistic infections. Due to the success of highly active antiretroviral therapies (HAART) in many patients, the new guidelines recommend that drugs for prevention of opportunistic infections no longer need to be given life long.
"The 2001 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus" updates revisions published in the Morbidity and Mortality Weekly Report in 1999. The draft of the updated guidelines are available at www.hivatis.org.
"Over the past several years, it has become apparent that prophylaxis does not necessarily need to be life long," said Dr. Henry Masur, Chief of the Critical Care Medicine Department at the NIH Clinical Center, and co-chair of the USPHS/IDSA working group. "If HAART improves immune function, chemoprophylaxis may be safely stopped in certain circumstances. This can be a great benefit to patients since it reduces the number of pills taken each day, reduces the cost of therapy, and reduces potential toxic reactions and drug interactions."
Guidelines for prevention of the most common HIV related opportunistic infection, pneumocystis pneumonia, were originally drafted in 1989. They successfully informed health care providers and patients that pneumocystis pneumonia could be effectively prevented, and survival prolonged, by instituting drug therapy for life once the CD4 T lymphocyte count fell below 200 cells/uL. More comprehensive guidelines were issued in 1995, and updated in 1997 and 1999, to cover opportunistic infections in addition to pneumocystis.
The updated guidelines indicate that when HAART improves immunity as measured by the CD4+ T lymphocyte count, prophylaxis for pneumocystis pneumonia, toxoplasma encephalitis, Mycobacterium avium complex disease, cryptococcosis and cytomegalovirus disease can usually be discontinued with little risk that these disease will occur.
They detail when chemoprophylaxis designed to prevent initial infections can be stopped (primary prophylaxis) and when chemoprophylaxis designed to prevent recurrence can be discontinued (secondary prophylaxis) in adults. Pediatric recommendations are also provided.
The guidelines also stress the importance of hepatitis C screening for HIV patients, since they are at increased risk of developing complications due to hepatitis C.
"Clinicans are recognizing the importance of hepatitis C in causing disablitity and death in HIV infected patients," said Masur. "The course of hepatitis C can be accelerated in such patients, and hepatitis C can complicate the administration of life prolonging antiretroviral therapy."
The guidelines were drafted by the USPHS/IDSA Prevention of Opportunistic Infections Working Group created by the National Institutes of Health, the Centers for Disease Control and Prevention in cooperation with the Infectious Diseases Society of America. It is co-chaired by Masur, Dr. Jonathan E. Kaplan of the Centers for Disease Control, and Dr. King K. Holmes of the University of Washington, Seattle. The working group includes clinicians and patient advocates from North America and Europe.
The Warren Grant Magnuson Clinical Center is the research hospital of the National Institutes of Health. Through clinical research, physicians and scientists translate laboratory discoveries into better treatments, therapies and interventions to improve the nation's health. NIH is an agency of the U.S. Department of Health and Human Services.
Last Modified Septebmer 1, 2002