Jonathan E. Kaplan and Harold W. Jaffe of the Centers for Disease Control
and Prevention and colleagues have written a response to a letter to the
editor in the Journal of the American Medical Association.

In their response, they write that the letterwritten by David C. Perlman
and colleaguesraises two issues relevant to the U.S. Public Health
Service/Infectious Diseases Society of America guidelines on the prevention
of opportunistic infections in HIVpositive persons.

In both 1995 and 1997, the authors note, the scope of the guidelines was
limited to the opportunistic infections of greatest importance in
HIVpositive individuals. Perlman's letter, however, addresses the risks of
infectious diseases among HIVpositive intravenous drug users, a population
with a fastgrowing HIV infection rate. This raises questions regarding the
inclusion of such diseases in the guidelines.

Additionally, Kaplan et al. note, Perlman's letter raises questions about
the system used to rate the strength of diseasespecific recommendations in
the guidelines and the quality of evidence supporting those recommendations.

In conclusion, the authors agree with Perlman that the infection risks and
prevention methods associated with intravenous drug use, especially those
that meet the definition of opportunistic infections, such as bacterial
endocarditis, should be included in future editions of the guidelines.
Nonopportunistic, riskgroup specific infections that are also transmitted
through sexual contactsuch as syphilis, gonorrhea, chlamydia, giardiasis,
and hepatitis A and Bshould also be included.