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July 2008
Volume 18, Number 7
HIV Opportunistic Infections Guidelines Updated

Updated guidelines for the prevention and treatment of opportunistic infections in HIV-infected patients—one on adults and adolescents, one on children—have been published by the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and HIVMA. The new documents revise and combine separate prevention guidelines and treatment guidelines published earlier.

The adult and adolescent guidelines include up-to-date information on new diagnostics such as interferon-gamma release assays for latent tuberculosis infection, new antifungal therapies, and new sections on malaria and hepatitis B. Rifamycin drug interactions affecting tuberculosis prevention and treatment are covered.

The adult and adolescent guidelines also include new information on the confounding issue of immune reconstruction inflammatory syndrome (IRIS). IRIS is challenging to manage because it is poorly defined and difficult to distinguish from worsening of an existing OI, development of a new OI, drug toxicity, or unrelated organ problems.

New emphasis is placed on the importance of antiretroviral therapy (ART) in the prevention of OI. “While preventing and managing OI is important, the overall public health message is that early identification of HIV and active management with antiretrovirals will avoid many of these problems,” said Henry Masur, MD, FIDSA, co-chair of the guidelines panel, chief of the Critical Care Medicine Department at NIH, and former IDSA president.

The pediatric guidelines include new sections on malaria, bartonella, aspergillosis, human herpesviruses 6, 7, and 8, and progressive multifocal leukoencephalopathy, and also cover IRIS—all of which previously were only covered in the adult guidelines.

Pediatric guidelines working group member Anne Gershon, MD, FIDSA, director of the Columbia University Pediatric Infectious Disease Division and IDSA president elect, said the new guidelines contain “much more information on safety and effectiveness of vaccines in HIV-infected children, including those against hepatitis A and B, varicella, rotavirus, and MMR, as well as meningococcal, and pneumococcal vaccines.”

In addition to this and other added content, “There are changes related to readability, such as new subsections on monitoring and adverse events and

IRIS, and management of treatment failure,” said Lynne Mofenson, MD, executive secretary of the pediatric guidelines core working group and chief of the National Institute of Child Health and Human Development’s Pediatric, Adolescent and Maternal AIDS Branch. “Much of this information was in the prior document but now is in separate sections and therefore is easier to find.”

The guidelines currently are available from the AIDSinfo website. They have been submitted for publication in CDC’s Morbidity and Mortality Weekly Report.
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