August 31, 2009

CDC Publishes New Opportunistic Infection Guidelines for HIV-Positive Children

Revised guidelines regarding the prevention and treatment of AIDS-related opportunistic infections (OIs) among HIV-infected children were published August 26 online in the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. A panel of more than 30 government and nongovernment pediatric HIV and infectious disease experts developed the guidelines, which both update and combine a 2002 and 2004 publication on the treatment of opportunistic infections in children.

“Current HAART regimens suppress viral replication, provide significant immune reconstitution and have resulted in a substantial and dramatic decrease in [AIDS]-related OIs and deaths in both adults and children,” the authors explained in their introduction to the revised “Guidelines for the Prevention and Treatment of Opportunistic Infections Among HIV-Exposed and HIV-Infected Children.” Yet, “despite this progress, prevention and management of OIs remain critical components of care for HIV-infected children.”

The new guidelines, issued jointly by the CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the American Academy of Pediatrics, provide a reference manual for the treatment of secondary infections related to HIV, describe warning signs of potentially hazardous interactions between drugs used to treat HIV and its secondary infections, describe current standards for treating the inflammation accompanying immune system recovery made possible by new antiretrovirals and provide guidance about when to discontinue preventive treatment no longer needed after the immune system has recovered.

New information added to the 2009 guidelines includes instructions on using antibiotic drugs to prevent Pneumocystis pneumonia (PCP) in infants; a section outlining treatments for malaria, which may become an opportunistic infection in HIV-infected immigrant children or HIV-infected children who travel to countries with malaria; and recommendations on when to discontinue medication for preventing opportunistic infections.

The new guidelines—as well as all federal HIV prevention and treatment guidelines—appear on the AIDSinfo website, aidsinfo.nih.gov/.

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