2001 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected With Human Immunodeficienc

1. 2001 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected With Human Immunodeficiency Virus Module 3: Prevention of Exposure A Training Slide Set Prepared by the AETC National Resource Center OI Guidelines 11/28/01

2. Disclaimer These slides were developed using the most recent treatment guideline information at the time of production. However, in the rapidly changing field of HIV care this information could become out of date quickly. The user is encouraged to compare the date of this slide set with the date of the most recent guidelines. Also, it is intended that these slides be used, as prepared, without changes in either content or attribution. Users are asked to honor this intent. AETC National Resource Center OI Guidelines 11/28/01

3. Prevention of Exposure Currently there are no recommendations for preventing exposure to: • P. carinii – no data to support isolation • M. avium Complex (MAC) – no data • S. pneumoniae and H. influenzae – not practical • Candidiasis - not practical • Cryptococcosis - not practical OI Guidelines 11/28/01

4. Toxoplasmosis • Test for Toxoplasma IgG antibody soon after the diagnosis of HIV infection to detect latent infection • Counsel all HIV + persons, particularly if IgG Ab-, to avoid the various sources of toxoplasmic infection including: food, pets, soil exposures, etc. OI Guidelines 11/28/01

5. Cryptosporidiosis Educate and counsel HIV-infected persons about transmission of Cryptosporidium: • Contact with infected adults and children. • Contact with infected animals. • Drinking or contact with contaminated water (e.g. Lakes, rivers). • Drinking contaminated public water supplies. • Eating contaminated food. OI Guidelines 11/28/01

6. Cryptosporidiosis • Use standard precautions to prevent transmission of cryptosporidiosis from an infected patient to a susceptible HIV-infected person. • Some experts recommend that HIV-infected persons,especially those who are severely immunocompromised, should not share a room with a patient with cryptosporidiosis. OI Guidelines 11/28/01

7. Tuberculosis • Counsel on potential risk of volunteer work or employment in high-risk settings. • In discussing risk of volunteer work or employment consider: specific duties, prevalence of tuberculosis in the community, and the precautions taken to prevent the transmission of tuberculosis in the workplace • Continuation of such activities might affect TB screening frequency. OI Guidelines 11/28/01

8. Bacterial Enteric Infections Food • Do not eat raw or undercooked eggs, raw or undercooked poultry, meat, seafood or other high-risk foods. • Avoid soft cheeses, meat pates and cold deli items. • Avoid cross contamination of foods and wash hands after preparation. OI Guidelines 11/28/01

9. Bacterial Enteric Infections Pets Avoid: • a new pet < 6 months old, especially those that have diarrhea. • contact with animals that have diarrhea. • contact with pets' feces. • contact with reptiles, chicks and ducklings because of the risk for salmonellosis. Wash hands after handling pets. OI Guidelines 11/28/01

10. Bacterial Enteric Infections Travel • The risk for food/water-borne infections is higher during travel to developing countries. • Avoid high-risk foods and beverages: raw foods, tap water, those sold by street vendors. • Generally safe: steaming-hot foods and beverages, fruits that are peeled by the traveler, and bottled beverages. • Boil water or use iodine or chlorine when boiling is not practical. OI Guidelines 11/28/01

11. Histoplasmosis • Exposure in histoplasmosis-endemic areas cannot completely avoided. • Patients with CD4+ < 200 cells/µL should avoid risky activities (e.g., dusty surface soil; cleaning chicken coops, etc.). OI Guidelines 11/28/01

12. Coccidioidomycosis • Exposure in Coccidioidomycosis -endemic areas cannot completely avoided. • Avoid risky activities (e.g. exposure to disturbed native soil, building excavation sites or dust storms). OI Guidelines 11/28/01

13. Cytomegalovirus Disease • Persons in risk groups with low rates of CMV seropositivity should be tested for antibody. • Use condoms consistently • Counsel on transmission from children. • CMV seronegatives requiring blood transfusion should be given only CMV antibody-negative or leukocyte-reduced cellular blood products in • nonemergency situations. OI Guidelines 11/28/01

14. Herpes Simplex Virus Disease Consistent use of condoms during sex. OI Guidelines 11/28/01

15. Varicella-Zoster Virus Disease Avoid exposure to others with zoster. Immunize household contacts of HIV+ persons. OI Guidelines 11/28/01

16. Human Herpesvirus 8 Infection(Kaposi’s Sarcoma-Associated Herpes Virus) Counsel about deep kissing and sexual intercourse with high risk persons. Consistent use of condoms during sex. Do not share IV drug equipment OI Guidelines 11/28/01

17. Human Papillomavirus Infection Consistent use of condoms during sex although no proof that this reduces risk for HPV OI Guidelines 11/28/01

18. Hepatitis C Virus Infection Drug using patients should be advised to: Cease drug use and enter and complete drug treatment. Use standard methods to avoid transmission if they continue to use drugs. Avoid tatoos Do not share dental appliances, razors, or other personal care articles. Safe-sexual practices to reduce the risk for exposure to sexually transmitted pathogens. OI Guidelines 11/28/01

19. For Additional Information: Sources of Complete Guidelines: • AETC Resource Center: www.aids-ed.org • AIDS Treatment Information Service: www.hivatis.org OI Guidelines 11/28/01

20. OI Guideline Slides December 2001 Author: John G. Bartlett, M.D. Editor: Richard W. Dunning, M.H.S. Reviewers: • Renslow Sherer, M.D. • Caroline Teter, PAC, M.P.H. OI Guidelines 11/28/01