Joint guidelines updated for treatment of opportunistic infections in children with HIV

Guidelines for the prevention and treatment of opportunistic infections among children exposed to HIV and children with HIV have recently been updated for the first time since 2009. They were released as a joint effort by the NIH, CDC, HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the AAP.

The guidelines are aimed at providing physicians and health care workers with information for treating opportunistic pathogens that occur in the United States and ones that can be acquired during international travel in children with HIV and children exposed to HIV. Each section includes epidemiology; clinical presentation; diagnosis of the infection in children; prevention of exposure; prevention of first episode of the disease; discontinuation of primary prophylaxis after immune reconstitution; treatment of disease; monitoring for adverse effects during treatment; management of treatment failure; prevention of disease recurrence; and discontinuation of secondary prophylaxis after immune reconstitution.

Major changes to the guidelines include:

More emphasis on antiretroviral therapy for the prevention and treatment of opportunistic infections, especially for those without a specific therapy;
More information on the management and diagnosis of immune reconstitution inflammatory syndrome;
Potential drug-drug interactions through information about managing ART in children with opportunistic infections;
Immunization recommendations updated for the pneumococcal, HPV, meningococcal and rotavirus vaccines;
New sections on influenza, giardiasis and isosporiasis;
Deletion of sections on aspergillosis, bartonellosis, human herpes virus-6, human herpes virus-7 infections; and
New updates for recommendations on the discontinuation of opportunistic infection prophylaxis following immune reconstitution in children.

Mothers with HIV are more likely to have coinfections with opportunistic infections than mothers without HIV, which increases the risk of passing on the infections to their children. The guidelines also cover treatment of opportunistic infections for children, both with HIV and without, born to mothers with HIV.

To view the complete guidelines, go to aidsinfo.nih.gov. The guidelines also were published in a supplement to The Pediatric Infectious Disease Journal.

For more information:

Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children. Available at: http://aidsinfo.nih.gov/guidelines/html/5/pediatric-oi-prevention-and-treatment-guidelines/0. Accessed Nov. 12, 2013.

Disclosure: See guidelines for a full list of disclosures.