Guidelines Revamped for Managing Pediatric HIV and Opportunistic Infections
Because the treatment of opportunistic infections (OIs) is an evolving science, and because the availability of new agents or new clinical data on existing agents can change the way OIs are treated in children with HIV/AIDS, an expert panel has revised its guideline on the recommended approach to prevention and management.
The National Institutes of Health (NIH), the Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Disease Society, and the American Academy of Pediatrics on Nov. 6 released the updated Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children.1
The guidelines are intended for use by health care providers who care for HIV-exposed and HIV-infected children in the United States. The panelists were supported by the NIH's Office of AIDS Research. The guidelines were last updated in 2009.2
Among the key changes in the guidelines:
• A greater emphasis on the importance of antiretroviral therapy (ART) for preventing and treating OIs, especially OIs for which no specific therapy exists.
• Increased information about the diagnosis and management of immune reconstitution inflammatory syndrome.
• Information about managing ART in children with OIs, including potential drug-drug interactions.
• Updated immunization recommendations for HIV-exposed and HIV-infected children, including pneumococcal, human papillomavirus, meningococcal, and rotavirus vaccines.
• New sections on influenza, giardiasis, and isosporiasis and the deletion of sections on aspergillosis, bartonellosis, and human herpesvirus 6 and 7 infections.
• Updated recommendations on discontinuing OI prophylaxis after immune reconstitution in children.
In addition to information on the diagnosis, prevention, and treatment of each OI, each section of the guidelines includes a summary of the key recommendations for each OI and a table of medication dosing recommendations.
A noteworthy change has been made to standardize the terminology used to describe the use of antiretroviral (ARV) medications. The term combination antiretroviral therapy (cART) indicates the use of multiple (generally 3 or more) ARVs as part of an HIV treatment regimen designed to achieve virologic suppression. The term highly active antiretroviral therapy (HAART) is no longer used and has been replaced by cART. The term ART has been used when referring to use of ARVs for HIV treatment more generally, including (mostly historical) use of 1- or 2-agent ARV regimens that do not meet criteria for cART.
—Michael Gerchufsky
References:
1. Siberry GK, Abzug MJ, Nachman S, et al; Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. http://aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf. Published November 6, 2013. Accessed November 18, 2013.
2. Mofenson LM, Brady MT, Danner SP, et al. Guidelines for the prevention and treatment of opportunistic infections among HIV-exposed and HIV-infected children: recommendations from 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. MMWR Recomm Rep. 2009;58(RR-11):1-166.
More on pediatric HIV/AIDS from Consultant for Pediatricians:
• Cutaneous Manifestations of HIV Infection in Children Part 1: Infection, by Wolfgang P. Rennert, MD, DMSc, DTM&H
• Cutaneous Manifestations of HIV Infection in Children Part 2: Noninfectious Complications, by Wolfgang P. Rennert, MD, DMSc, DTM&H
• HIV in Haiti, by Consultant for Pediatricians blogger Lane M. Robson, MD
• Child With Dysphagia, Fever, and Weight Loss, by Josefina L. Choe, DO, and Paul Lee, MD