PREVENTIVE HEALTH-CARE FOR ADULTS WITH HIV-INFECTION

被引:49
作者
JEWETT, JF
HECHT, FM
机构
[1] UNIV CALIF SAN FRANCISCO, SFGH, DGIM, BOX 0862, 3RD & PARNASSUS AVE, SAN FRANCISCO, CA 94143 USA
[2] MARTHA ELIOT HLTH CTR, BOSTON, MA USA
[3] MONTEFIORE MED CTR, RESIDENCY PROGRAM SOCIAL MED FAC, BRONX, NY USA
[4] BRIGHAM & WOMENS HOSP, DEPT MED, BOSTON, MA 02115 USA
[5] HARVARD UNIV, CHILDRENS HOSP, BOSTON, MA 02115 USA
[6] MONTEFIORE MED CTR, DEPT MED, BRONX, NY 10467 USA
[7] UNIV CALIF SAN FRANCISCO, DEPT MED, SAN FRANCISCO, CA 94143 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 1993年 / 269卷 / 09期
关键词
D O I
10.1001/jama.269.9.1144
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective.-To assess the level of evidence for preventive health interventions for adults with human immunodeficiency virus (HIV) infection. Data Sources.-A MEDLINE literature search for each intervention, supplemented by reviewing conference proceedings and the recommendations of experts. Study Selection.-English-language studies of interventions that contribute to one of the following goals were reviewed: (1) prevention of complications of HIV infection; (2) early detection of complications, before symptoms develop, at a stage in which early treatment could lead to improved outcome; (3) slowing of HIV disease progression; (4) reduction in the risk of transmission of infectious agents, such as HIV itself; and (5) prevention of psychological distress and improvement in the quality of life. Data Extraction.-The importance of interventions and quality of supporting evidence were evaluated using criteria modified from the US Preventive Services Task Force. Data Synthesis.-Existing evidence strongly supports the efficacy of some preventive measures: primary and secondary Pneumocystis carinii pneumonia prophylaxis; secondary prophylaxis of Cryptococcus, Toxoplasma, and cytomegalovirus infections; tuberculin testing, with chemotherapy for individuals with positive test results; syphilis screening; Papanicolaou tests; educational measures to reduce the transmission of HIV and other infections; T-lymphocyte monitoring; and antiretroviral therapy in selected patients. Recommended measures of possible, but less certain, effectiveness include vaccines to prevent influenza, Haemophilus influenzae, pneumococcal, and hepatitis B infections; prophylaxis for recurrent esophageal and vaginal candidiasis; primary prophylaxis of Mycobacterium avium complex; tuberculosis prophylaxis for anergic, high-risk individuals; routine physical examination; screening for gonorrhea and Chlamydia in high-risk women; monitoring Toxoplasma titers, complete blood cell counts, and serum chemistry values; attempting to maintain weight through nutritional interventions; and exercise. Mental health and substance abuse interventions are probably very important, but documentation of their benefits is limited. Some measures require further study before they can routinely be recommended, including vitamin and mineral supplementation; specific nutritional diets; and laboratory tests, other than CD4 counts, for monitoring disease progression. Conclusions.-Persons with HIV infection have different stage-specific health maintenance needs that form an important part of comprehensive care for people in all stages of infection.
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页码:1144 / 1153
页数:10
相关论文
共 239 条
[1]  
ALWOOD K, 1989, 5TH INT C AIDS MONTR
[2]  
AMPEL NM, 1990, 6TH INT C AIDS SAN F
[3]   USE OF BETA-2-MICROGLOBULIN LEVEL AND CD4 LYMPHOCYTE COUNT TO PREDICT DEVELOPMENT OF ACQUIRED-IMMUNODEFICIENCY-SYNDROME IN PERSONS WITH HUMAN IMMUNODEFICIENCY VIRUS-INFECTION [J].
ANDERSON, RE ;
LANG, W ;
SHIBOSKI, S ;
ROYCE, R ;
JEWELL, N ;
WINKELSTEIN, W .
ARCHIVES OF INTERNAL MEDICINE, 1990, 150 (01) :73-77
[4]  
[Anonymous], 1992, MMWR Recomm Rep, V41, P1
[5]  
[Anonymous], [No title captured]
[6]  
[Anonymous], 1989, GUIDE CLIN PREVENTIV
[7]  
BALLET JJ, 1987, CLIN EXP IMMUNOL, V68, P479
[8]  
BALSDON MJ, 1988, GENITOURIN MED, V64, P124
[9]   TUBERCULOSIS IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION [J].
BARNES, PF ;
BLOCH, AB ;
DAVIDSON, PT ;
SNIDER, DE .
NEW ENGLAND JOURNAL OF MEDICINE, 1991, 324 (23) :1644-1650
[10]  
BAUM MK, 1991, J ACQ IMMUN DEF SYND, V4, P1122