The National Institutes of Health (NIH) and the U.S. Centers for Disease Control and Prevention (CDC) last week published new guidelines for the prevention and treatment of opportunistic infections in children exposed to or infected with HIV. The revised recommendations -- the first update in 5 years -- appear in the August 26, 2009 early release edition of Morbidity and Mortality Weekly Report (MMWR).

By Ronald Baker, PhD

The revised recommendations cover 23 opportunistic infections (both classic AIDS-defining OIs and other infections commonly seen in children with HIV), with information on primary prevention, treatment, and maintenance therapy.

The guidelines feature an emphasis on the importance of effective antiretroviral therapy (ART) to improve immune function in children, information on the diagnosis and management of immune reconstitution inflammatory syndrome (IRIS), potential drug interactions, new guidance on prevention of Pneumocystis pneumonia in infants, and updated immunization recommendations for hepatitis A, human papillomavirus (HPV), meningococcal disease, and rotavirus.

"The guidelines will help health care workers and public health officials who work with children to save lives that might otherwise be lost," said Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services. "The infections that can accompany HIV are often the major cause of illness and death of HIV-infected children."

"We hope that doctors and clinicians make use of these new guidelines to ensure that adolescents with HIV are not severely impacted by other infections," said Kenneth Dominguez, MD, a coauthor of the new guidelines and epidemiologist at CDC's Division of HIV/AIDS Prevention. "Despite our country's strong success in preventing perinatally HIV-infected infants, we must protect the significant numbers of current HIV-infected children and adolescents who are able to live longer, healthier lives due to advances in HIV therapy."

Full press release

Full text of updated guidelines

9/01/09

Reference
CDC, NIH, HIV Medicine Association of the Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and American Academy of Pediatrics. Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected Children. Morbidity and Mortality Weekly Report 58: 1-166. August 26, 2009 (early release); September 4, 2009 (print edition).

Other source
NIH News. U.S. Updates Clinical Guidelines for Prevention and Treatment of Opportunistic Infections among HIV-Exposed and HIV-Infected Children. August 26, 2009.