Skip to main content
Infectious Diseases in Obstetrics and Gynecology logoLink to Infectious Diseases in Obstetrics and Gynecology
. 2000;8(1):5–74. doi: 10.1155/S1064744900000028

1999 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. U.S. Public Health Service (USPHS) and Infectious Diseases Society of America (IDSA).

PMCID: PMC1784664  PMID: 10741830

Full Text

The Full Text of this article is available as a PDF (8.8 MB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adair C. D., Gunter M., Stovall T. G., McElroy G., Veille J. C., Ernest J. M. Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin. Obstet Gynecol. 1998 Feb;91(2):165–168. doi: 10.1016/s0029-7844(97)00586-3. [DOI] [PubMed] [Google Scholar]
  2. Aleck K. A., Bartley D. L. Multiple malformation syndrome following fluconazole use in pregnancy: report of an additional patient. Am J Med Genet. 1997 Oct 31;72(3):253–256. [PubMed] [Google Scholar]
  3. Bozzette S. A., Finkelstein D. M., Spector S. A., Frame P., Powderly W. G., He W., Phillips L., Craven D., van der Horst C., Feinberg J. A randomized trial of three antipneumocystis agents in patients with advanced human immunodeficiency virus infection. NIAID AIDS Clinical Trials Group. N Engl J Med. 1995 Mar 16;332(11):693–699. doi: 10.1056/NEJM199503163321101. [DOI] [PubMed] [Google Scholar]
  4. Brosgart C. L., Louis T. A., Hillman D. W., Craig C. P., Alston B., Fisher E., Abrams D. I., Luskin-Hawk R. L., Sampson J. H., Ward D. J. A randomized, placebo-controlled trial of the safety and efficacy of oral ganciclovir for prophylaxis of cytomegalovirus disease in HIV-infected individuals. Terry Beirn Community Programs for Clinical Research on AIDS. AIDS. 1998 Feb 12;12(3):269–277. doi: 10.1097/00002030-199803000-00004. [DOI] [PubMed] [Google Scholar]
  5. Carr A., Tindall B., Brew B. J., Marriott D. J., Harkness J. L., Penny R., Cooper D. A. Low-dose trimethoprim-sulfamethoxazole prophylaxis for toxoplasmic encephalitis in patients with AIDS. Ann Intern Med. 1992 Jul 15;117(2):106–111. doi: 10.7326/0003-4819-117-2-106. [DOI] [PubMed] [Google Scholar]
  6. Chaisson R. E., Benson C. A., Dube M. P., Heifets L. B., Korvick J. A., Elkin S., Smith T., Craft J. C., Sattler F. R. Clarithromycin therapy for bacteremic Mycobacterium avium complex disease. A randomized, double-blind, dose-ranging study in patients with AIDS. AIDS Clinical Trials Group Protocol 157 Study Team. Ann Intern Med. 1994 Dec 15;121(12):905–911. doi: 10.7326/0003-4819-121-12-199412150-00001. [DOI] [PubMed] [Google Scholar]
  7. Chaisson R. E., Keiser P., Pierce M., Fessel W. J., Ruskin J., Lahart C., Benson C. A., Meek K., Siepman N., Craft J. C. Clarithromycin and ethambutol with or without clofazimine for the treatment of bacteremic Mycobacterium avium complex disease in patients with HIV infection. AIDS. 1997 Mar;11(3):311–317. doi: 10.1097/00002030-199703110-00008. [DOI] [PubMed] [Google Scholar]
  8. Chemello L., Cavalletto L., Casarin C., Bonetti P., Bernardinello E., Pontisso P., Donada C., Belussi F., Martinelli S., Alberti A. Persistent hepatitis C viremia predicts late relapse after sustained response to interferon-alpha in chronic hepatitis C. TriVeneto Viral Hepatitis Group. Ann Intern Med. 1996 Jun 15;124(12):1058–1060. doi: 10.7326/0003-4819-124-12-199606150-00005. [DOI] [PubMed] [Google Scholar]
  9. Cytomegalovirus (CMV) culture results, drug resistance, and clinical outcome in patients with AIDS and CMV retinitis treated with foscarnet or ganciclovir. Studies of Ocular Complications of AIDS (SOCA) in collaboration with the AIDS Clinical Trial Group. J Infect Dis. 1997 Jul;176(1):50–58. doi: 10.1086/514039. [DOI] [PubMed] [Google Scholar]
  10. Dannemann B., McCutchan J. A., Israelski D., Antoniskis D., Leport C., Luft B., Nussbaum J., Clumeck N., Morlat P., Chiu J. Treatment of toxoplasmic encephalitis in patients with AIDS. A randomized trial comparing pyrimethamine plus clindamycin to pyrimethamine plus sulfadiazine. The California Collaborative Treatment Group. Ann Intern Med. 1992 Jan 1;116(1):33–43. doi: 10.7326/0003-4819-116-1-33. [DOI] [PubMed] [Google Scholar]
  11. Darby S. C., Ewart D. W., Giangrande P. L., Spooner R. J., Rizza C. R., Dusheiko G. M., Lee C. A., Ludlam C. A., Preston F. E. Mortality from liver cancer and liver disease in haemophilic men and boys in UK given blood products contaminated with hepatitis C. UK Haemophilia Centre Directors' Organisation. Lancet. 1997 Nov 15;350(9089):1425–1431. doi: 10.1016/s0140-6736(97)05413-5. [DOI] [PubMed] [Google Scholar]
  12. Drew W. L., Ives D., Lalezari J. P., Crumpacker C., Follansbee S. E., Spector S. A., Benson C. A., Friedberg D. N., Hubbard L., Stempien M. J. Oral ganciclovir as maintenance treatment for cytomegalovirus retinitis in patients with AIDS. Syntex Cooperative Oral Ganciclovir Study Group. N Engl J Med. 1995 Sep 7;333(10):615–620. doi: 10.1056/NEJM199509073331002. [DOI] [PubMed] [Google Scholar]
  13. El-Sadr W. M., Murphy R. L., Yurik T. M., Luskin-Hawk R., Cheung T. W., Balfour H. H., Jr, Eng R., Hooton T. M., Kerkering T. M., Schutz M. Atovaquone compared with dapsone for the prevention of Pneumocystis carinii pneumonia in patients with HIV infection who cannot tolerate trimethoprim, sulfonamides, or both. Community Program for Clinical Research on AIDS and the AIDS Clinical Trials Group. N Engl J Med. 1998 Dec 24;339(26):1889–1895. doi: 10.1056/NEJM199812243392604. [DOI] [PubMed] [Google Scholar]
  14. Furrer H., Egger M., Opravil M., Bernasconi E., Hirschel B., Battegay M., Telenti A., Vernazza P. L., Rickenbach M., Flepp M. Discontinuation of primary prophylaxis against Pneumocystis carinii pneumonia in HIV-1-infected adults treated with combination antiretroviral therapy. Swiss HIV Cohort Study. N Engl J Med. 1999 Apr 29;340(17):1301–1306. doi: 10.1056/NEJM199904293401701. [DOI] [PubMed] [Google Scholar]
  15. Gebo K. A., Moore R. D., Keruly J. C., Chaisson R. E. Risk factors for pneumococcal disease in human immunodeficiency virus-infected patients. J Infect Dis. 1996 Apr;173(4):857–862. doi: 10.1093/infdis/173.4.857. [DOI] [PubMed] [Google Scholar]
  16. Goldie S. J., Kuntz K. M., Weinstein M. C., Freedberg K. A., Welton M. L., Palefsky J. M. The clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive men. JAMA. 1999 May 19;281(19):1822–1829. doi: 10.1001/jama.281.19.1822. [DOI] [PubMed] [Google Scholar]
  17. Gross P. A., Barrett T. L., Dellinger E. P., Krause P. J., Martone W. J., McGowan J. E., Jr, Sweet R. L., Wenzel R. P. Purpose of quality standards for infectious diseases. Infectious Diseases Society of America. Clin Infect Dis. 1994 Mar;18(3):421–421. doi: 10.1093/clinids/18.3.421. [DOI] [PubMed] [Google Scholar]
  18. Hardy W. D., Feinberg J., Finkelstein D. M., Power M. E., He W., Kaczka C., Frame P. T., Holmes M., Waskin H., Fass R. J. A controlled trial of trimethoprim-sulfamethoxazole or aerosolized pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. AIDS Clinical Trials Group Protocol 021. N Engl J Med. 1992 Dec 24;327(26):1842–1848. doi: 10.1056/NEJM199212243272604. [DOI] [PubMed] [Google Scholar]
  19. Havlir D. V., Dubé M. P., McCutchan J. A., Forthal D. N., Kemper C. A., Dunne M. W., Parenti D. M., Kumar P. N., White A. C., Jr, Witt M. D. Prophylaxis with weekly versus daily fluconazole for fungal infections in patients with AIDS. Clin Infect Dis. 1998 Dec;27(6):1369–1375. doi: 10.1086/515018. [DOI] [PubMed] [Google Scholar]
  20. Havlir D. V., Dubé M. P., Sattler F. R., Forthal D. N., Kemper C. A., Dunne M. W., Parenti D. M., Lavelle J. P., White A. C., Jr, Witt M. D. Prophylaxis against disseminated Mycobacterium avium complex with weekly azithromycin, daily rifabutin, or both. California Collaborative Treatment Group. N Engl J Med. 1996 Aug 8;335(6):392–398. doi: 10.1056/NEJM199608083350604. [DOI] [PubMed] [Google Scholar]
  21. Holmberg S. D., Moorman A. C., Von Bargen J. C., Palella F. J., Loveless M. O., Ward D. J., Navin T. R. Possible effectiveness of clarithromycin and rifabutin for cryptosporidiosis chemoprophylaxis in HIV disease. HIV Outpatient Study (HOPS) Investigators. JAMA. 1998 Feb 4;279(5):384–386. doi: 10.1001/jama.279.5.384. [DOI] [PubMed] [Google Scholar]
  22. Kaplan J. E., Hanson D. L., Navin T. R., Jones J. L. Risk factors for primary Pneumocystis carinii pneumonia in human immunodeficiency virus-infected adolescents and adults in the United States: reassessment of indications for chemoprophylaxis. J Infect Dis. 1998 Oct;178(4):1126–1132. doi: 10.1086/515658. [DOI] [PubMed] [Google Scholar]
  23. Kaplan J. E., Masur H., Jaffe H. W., Holmes K. K. Preventing opportunistic infections in persons infected with HIV: 1997 guidelines. JAMA. 1997 Jul 23;278(4):337–338. [PubMed] [Google Scholar]
  24. Katlama C., De Wit S., O'Doherty E., Van Glabeke M., Clumeck N. Pyrimethamine-clindamycin vs. pyrimethamine-sulfadiazine as acute and long-term therapy for toxoplasmic encephalitis in patients with AIDS. Clin Infect Dis. 1996 Feb;22(2):268–275. doi: 10.1093/clinids/22.2.268. [DOI] [PubMed] [Google Scholar]
  25. Kurman R. J., Henson D. E., Herbst A. L., Noller K. L., Schiffman M. H. Interim guidelines for management of abnormal cervical cytology. The 1992 National Cancer Institute Workshop. JAMA. 1994 Jun 15;271(23):1866–1869. [PubMed] [Google Scholar]
  26. Martin D. F., Kuppermann B. D., Wolitz R. A., Palestine A. G., Li H., Robinson C. A. Oral ganciclovir for patients with cytomegalovirus retinitis treated with a ganciclovir implant. Roche Ganciclovir Study Group. N Engl J Med. 1999 Apr 8;340(14):1063–1070. doi: 10.1056/NEJM199904083401402. [DOI] [PubMed] [Google Scholar]
  27. Masur H. Recommendations on prophylaxis and therapy for disseminated Mycobacterium avium complex disease in patients infected with the human immunodeficiency virus. Public Health Service Task Force on Prophylaxis and Therapy for Mycobacterium avium Complex. N Engl J Med. 1993 Sep 16;329(12):898–904. doi: 10.1056/NEJM199309163291228. [DOI] [PubMed] [Google Scholar]
  28. McKinsey D. S., Wheat L. J., Cloud G. A., Pierce M., Black J. R., Bamberger D. M., Goldman M., Thomas C. J., Gutsch H. M., Moskovitz B. Itraconazole prophylaxis for fungal infections in patients with advanced human immunodeficiency virus infection: randomized, placebo-controlled, double-blind study. National Institute of Allergy and Infectious Diseases Mycoses Study Group. Clin Infect Dis. 1999 May;28(5):1049–1056. doi: 10.1086/514744. [DOI] [PubMed] [Google Scholar]
  29. Opravil M., Hirschel B., Lazzarin A., Heald A., Pechère M., Rüttimann S., Iten A., von Overbeck J., Oertle D., Praz G. Once-weekly administration of dapsone/pyrimethamine vs. aerosolized pentamidine as combined prophylaxis for Pneumocystis carinii pneumonia and toxoplasmic encephalitis in human immunodeficiency virus-infected patients. Clin Infect Dis. 1995 Mar;20(3):531–541. doi: 10.1093/clinids/20.3.531. [DOI] [PubMed] [Google Scholar]
  30. Palella F. J., Jr, Delaney K. M., Moorman A. C., Loveless M. O., Fuhrer J., Satten G. A., Aschman D. J., Holmberg S. D. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998 Mar 26;338(13):853–860. doi: 10.1056/NEJM199803263381301. [DOI] [PubMed] [Google Scholar]
  31. Palestine A. G., Polis M. A., De Smet M. D., Baird B. F., Falloon J., Kovacs J. A., Davey R. T., Zurlo J. J., Zunich K. M., Davis M. A randomized, controlled trial of foscarnet in the treatment of cytomegalovirus retinitis in patients with AIDS. Ann Intern Med. 1991 Nov 1;115(9):665–673. doi: 10.7326/0003-4819-115-9-665. [DOI] [PubMed] [Google Scholar]
  32. Parenteral cidofovir for cytomegalovirus retinitis in patients with AIDS: the HPMPC peripheral cytomegalovirus retinitis trial. A randomized, controlled trial. Studies of Ocular complications of AIDS Research Group in Collaboration with the AIDS Clinical Trials Group. Ann Intern Med. 1997 Feb 15;126(4):264–274. doi: 10.7326/0003-4819-126-4-199702150-00002. [DOI] [PubMed] [Google Scholar]
  33. Pierce M., Crampton S., Henry D., Heifets L., LaMarca A., Montecalvo M., Wormser G. P., Jablonowski H., Jemsek J., Cynamon M. A randomized trial of clarithromycin as prophylaxis against disseminated Mycobacterium avium complex infection in patients with advanced acquired immunodeficiency syndrome. N Engl J Med. 1996 Aug 8;335(6):384–391. doi: 10.1056/NEJM199608083350603. [DOI] [PubMed] [Google Scholar]
  34. Podzamczer D., Salazar A., Jiménez J., Consiglio E., Santín M., Casanova A., Rufí G., Gudiol F. Intermittent trimethoprim-sulfamethoxazole compared with dapsone-pyrimethamine for the simultaneous primary prophylaxis of Pneumocystis pneumonia and toxoplasmosis in patients infected with HIV. Ann Intern Med. 1995 May 15;122(10):755–761. doi: 10.7326/0003-4819-122-10-199505150-00004. [DOI] [PubMed] [Google Scholar]
  35. Powderly W. G., Finkelstein D., Feinberg J., Frame P., He W., van der Horst C., Koletar S. L., Eyster M. E., Carey J., Waskin H. A randomized trial comparing fluconazole with clotrimazole troches for the prevention of fungal infections in patients with advanced human immunodeficiency virus infection. NIAID AIDS Clinical Trials Group. N Engl J Med. 1995 Mar 16;332(11):700–705. doi: 10.1056/NEJM199503163321102. [DOI] [PubMed] [Google Scholar]
  36. Pursley T. J., Blomquist I. K., Abraham J., Andersen H. F., Bartley J. A. Fluconazole-induced congenital anomalies in three infants. Clin Infect Dis. 1996 Feb;22(2):336–340. doi: 10.1093/clinids/22.2.336. [DOI] [PubMed] [Google Scholar]
  37. Rodríguez-Rosado R., García-Samaniego J., Soriano V. Hepatotoxicity after introduction of highly active antiretroviral therapy. AIDS. 1998 Jul 9;12(10):1256–1256. doi: 10.1097/00002030-199810000-00025. [DOI] [PubMed] [Google Scholar]
  38. Schacker T., Hu H. L., Koelle D. M., Zeh J., Saltzman R., Boon R., Shaughnessy M., Barnum G., Corey L. Famciclovir for the suppression of symptomatic and asymptomatic herpes simplex virus reactivation in HIV-infected persons. A double-blind, placebo-controlled trial. Ann Intern Med. 1998 Jan 1;128(1):21–28. doi: 10.7326/0003-4819-128-1-199801010-00004. [DOI] [PubMed] [Google Scholar]
  39. Schacker T., Zeh J., Hu H. L., Hill E., Corey L. Frequency of symptomatic and asymptomatic herpes simplex virus type 2 reactivations among human immunodeficiency virus-infected men. J Infect Dis. 1998 Dec;178(6):1616–1622. doi: 10.1086/314486. [DOI] [PubMed] [Google Scholar]
  40. Schneider M. M., Borleffs J. C., Stolk R. P., Jaspers C. A., Hoepelman A. I. Discontinuation of prophylaxis for Pneumocystis carinii pneumonia in HIV-1-infected patients treated with highly active antiretroviral therapy. Lancet. 1999 Jan 16;353(9148):201–203. doi: 10.1016/S0140-6736(98)07204-3. [DOI] [PubMed] [Google Scholar]
  41. Schneider M. M., Hoepelman A. I., Eeftinck Schattenkerk J. K., Nielsen T. L., van der Graaf Y., Frissen J. P., van der Ende I. M., Kolsters A. F., Borleffs J. C. A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. The Dutch AIDS Treatment Group. N Engl J Med. 1992 Dec 24;327(26):1836–1841. doi: 10.1056/NEJM199212243272603. [DOI] [PubMed] [Google Scholar]
  42. Schneider M. M., Nielsen T. L., Nelsing S., Hoepelman A. I., Eeftinck Schattenkerk J. K., van der Graaf Y., Kolsters A. F., Borleffs J. C. Efficacy and toxicity of two doses of trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus. Dutch AIDS Treatment Group. J Infect Dis. 1995 Jun;171(6):1632–1636. doi: 10.1093/infdis/171.6.1632. [DOI] [PubMed] [Google Scholar]
  43. Schuman P., Capps L., Peng G., Vazquez J., el-Sadr W., Goldman A. I., Alston B., Besch C. L., Vaughn A., Thompson M. A. Weekly fluconazole for the prevention of mucosal candidiasis in women with HIV infection. A randomized, double-blind, placebo-controlled trial. Terry Beirn Community Programs for Clinical Research on AIDS. Ann Intern Med. 1997 May 1;126(9):689–696. doi: 10.7326/0003-4819-126-9-199705010-00003. [DOI] [PubMed] [Google Scholar]
  44. Spector S. A., McKinley G. F., Lalezari J. P., Samo T., Andruczk R., Follansbee S., Sparti P. D., Havlir D. V., Simpson G., Buhles W. Oral ganciclovir for the prevention of cytomegalovirus disease in persons with AIDS. Roche Cooperative Oral Ganciclovir Study Group. N Engl J Med. 1996 Jun 6;334(23):1491–1497. doi: 10.1056/NEJM199606063342302. [DOI] [PubMed] [Google Scholar]
  45. Tural C., Romeu J., Sirera G., Andreu D., Conejero M., Ruiz S., Jou A., Bonjoch A., Ruiz L., Arnó A. Long-lasting remission of cytomegalovirus retinitis without maintenance therapy in human immunodeficiency virus-infected patients. J Infect Dis. 1998 Apr;177(4):1080–1083. doi: 10.1086/517399. [DOI] [PubMed] [Google Scholar]
  46. Villano S. A., Vlahov D., Nelson K. E., Lyles C. M., Cohn S., Thomas D. L. Incidence and risk factors for hepatitis C among injection drug users in Baltimore, Maryland. J Clin Microbiol. 1997 Dec;35(12):3274–3277. doi: 10.1128/jcm.35.12.3274-3277.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Vrabec T. R., Baldassano V. F., Whitcup S. M. Discontinuation of maintenance therapy in patients with quiescent cytomegalovirus retinitis and elevated CD4+ counts. Ophthalmology. 1998 Jul;105(7):1259–1264. doi: 10.1016/S0161-6420(98)97031-2. [DOI] [PubMed] [Google Scholar]
  48. Weverling G. J., Mocroft A., Ledergerber B., Kirk O., Gonzáles-Lahoz J., d'Arminio Monforte A., Proenca R., Phillips A. N., Lundgren J. D., Reiss P. Discontinuation of Pneumocystis carinii pneumonia prophylaxis after start of highly active antiretroviral therapy in HIV-1 infection. EuroSIDA Study Group. Lancet. 1999 Apr 17;353(9161):1293–1298. doi: 10.1016/s0140-6736(99)03287-0. [DOI] [PubMed] [Google Scholar]
  49. Wheat J., Hafner R., Wulfsohn M., Spencer P., Squires K., Powderly W., Wong B., Rinaldi M., Saag M., Hamill R. Prevention of relapse of histoplasmosis with itraconazole in patients with the acquired immunodeficiency syndrome. Ann Intern Med. 1993 Apr 15;118(8):610–616. doi: 10.7326/0003-4819-118-8-199304150-00006. [DOI] [PubMed] [Google Scholar]

Articles from Infectious Diseases in Obstetrics and Gynecology are provided here courtesy of Wiley

RESOURCES