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Updated Pediatric HIV Opportunistic Infection Guidelines Emphasize Antiretroviral Therapy

The U.S. National Institutes of Health, Centers for Disease Control and Prevention, and other medical associations have released an updated version of Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. The latest revision emphasizes the importance of timely antiretroviral therapy as a key to preventing and managing OIs in infants and children with HIV.

Below is an edited excerpt from an announcement from AIDSinfo summarizing the major changes to the guidelines. The full updated guidelines are available online.

Updated Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children Released

The National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Disease Society (PIDS), and the American Academy of Pediatrics (AAP) announce the release of the updated Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. The guidelines were simultaneously published in the Pediatric Infectious Disease Journal (PIDJ).

Selected key updates to the guidelines include the following:

• Greater emphasis on the importance of antiretroviral therapy (ART) for prevention and treatment of opportunistic infections (OIs), especially those OIs for which no specific therapy exists;
• Increased information about the diagnosis and management of immune reconstitution inflammatory syndrome (IRIS); 
• Information about managing ART in children with OIs, including potential drug-drug interactions; 
• Updated immunization recommendations for HIV-exposed and HIV-infected children, including pneumococcal, human papillomavirus, meningococcal, and rotavirus vaccines;
• Addition of sections on influenza, giardiasis, and isosporiasis;
• Elimination of sections on aspergillosis, bartonellosis, and human herpesvirus 6 (HHV-6) and HHV-7 infections; and 
• Updated recommendations on discontinuation of OI prophylaxis after immune reconstitution in children.

In addition to information on the diagnosis, prevention, and treatment of each OI, the guidelines include a summary of the most important recommendations for each OI at the beginning of each section and a table of dosing recommendations at the end of each section. Summary tables are included at the end of the document that list dosing recommendations for preventing and treating OIs in children, drug preparation and toxicity information for children, and major drug-drug interactions.

To view or download the guidelines, go to the Pediatric OI Prevention and Treatment Guidelines section of AIDSinfo. Separate PDF files of the tables can also be downloaded from the page.

Your Feedback Is Welcome

Feedback on the latest revisions to the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children is welcome. Please send your comments with the subject line "Comments on Pediatric OI Prevention and Treatment Guidelines" to JLIB_HTML_CLOAKING by November 20, 2013.

11/12/13

Sources

AIDSinfo-at-a-Glance. Updated Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children Released. November 6, 2013.

GK Siberry, MJ Abzug, S Nachman, et al. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children: Recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. Pediatric Infectious Disease Journal 32 (Supplement 2). November 2013.