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Guideline update on opportunistic infections in HIV-infected children released

NEW YORK (Reuters Health) – An US expert panel has issued updated guidelines for preventing and treating opportunistic infections (OIs) in HIV-exposed and infected children.

Jointly created by the National Institutes of Health, the 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, the new guidelines update previous recommendations issued in 2009.

The document includes updated immunization recommendations for HIV-exposed and HIV-infected children, including pneumococcal, human papillomavirus (HPV), meningococcal, and rotavirus vaccines.

“Ideally, HPV vaccine should be administered before an individual becomes sexually active,” the guidelines state. “HIV-infected individuals should use latex condoms during every act of sexual intercourse to reduce the risk of exposure to sexually transmitted pathogens, including HPV.”

And for influenza, “The approach to evaluation and treatment of HIV-infected children on stable combination antiretroviral therapy with suspected or confirmed influenza should be similar to that of HIV-uninfected children,” the guidelines say. “Prevention of influenza in HIV-infected children aged 6 months and older should include annual administration of trivalent inactivated influenza vaccine, according to Advisory Committee on Immunization Practices recommendations.”

They further advise, “Influenza-specific antiviral chemoprophylaxis should be considered for HIV-infected children based on level of immunosuppression and other preexisting co-morbidities, influenza vaccination status, and degree of exposure to suspected or confirmed influenza, according to CDC guidelines. HIV-infected children with confirmed influenza should be considered for prompt antiviral therapy, according to CDC guidelines.”

Panel member Dr. George Siberry, who is with the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Maryland, told Reuters Health by email that the new recommendations complement other US federal guidelines covering OIs in adults with HIV, as well as antiretroviral treatment of children, pregnant women, and adolescents and adults, “all of which are available at”

He said “selected key updates” to the guidelines include a greater emphasis on the importance of ART for prevention and treatment of OIs, especially those OIs for which no specific therapy exists, and guidance about managing ART in children with OIs, including potential drug-drug interactions.

The guidelines panel notes in a 16-page executive summary, published online November 27 in the Journal of the Pediatric Infectious Diseases Society, that “licensure of drugs for children and their application in clinical care often relies on efficacy data from adult trials in combination with pharmacokinetic, safety, and/or observational data in children.” Therefore, recommendations sometimes rely on trials in adults with only supporting data in children.

The update also includes “increased information about the diagnosis and management of immune reconstitution inflammatory syndrome (IRIS),” Dr. Siberry said, and “updated recommendations on discontinuation of OI prophylaxis after immune reconstitution in children.”

It also “address OIs that occur in children in the United States and ones that might occur during international travel, such as malaria,” Dr. Siberry said.

The panel has eliminated sections on aspergillosis, bartonellosis, and human herpesvirus 6 (HHV-6) and HHV-7 infections and added sections on influenza, giardiasis, and isosporiasis, he noted.


J Ped Infect Dis 2013.