Therefore, infections with opportunistic pathogens might affect not just HIV-infected infants but also HIV-exposed but uninfected infants who become infected by the pathogen because of transmission from HIV-infected mothers or family members with coinfections. In addition, HIV-infected women or HIV-infected family members coinfected with certain opportunistic pathogens might be more likely to transmit these infections horizontally to their children, resulting in increased likelihood of primary acquisition of such infections in the young child. The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of the evidence supporting the recommendation so readers can ascertain how best to apply the recommendations in their practice environments.Īn important mode of acquisition of OIs, as well as HIV infection among children, is from their infected mother HIV-infected women coinfected with opportunistic pathogens might be more likely than women without HIV infection to transmit these infections to their infants. After these presentations and discussions, the guidelines underwent further revision, with review and approval by the Working Group, and final endorsement by NIH, CDC, the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Disease Society (PIDS), and the American Academy of Pediatrics (AAP).
For each OI, a pediatric specialist with content-matter expertise reviewed the literature for new information since the last guidelines were published they then proposed revised recommendations at a meeting at the National Institutes of Health (NIH) in June 2007. The guidelines were developed by a panel of specialists in pediatric HIV infection and infectious diseases (the Pediatric Opportunistic Infections Working Group) from the U.S. A separate document about preventing and treating of OIs among HIV-infected adults and postpubertal adolescents ( Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents) was prepared by a working group of adult HIV and infectious disease specialists.
Topic areas covered for each OI include a brief description of the epidemiology, clinical presentation, and diagnosis of the OI in children prevention of exposure prevention of disease by chemoprophylaxis and/or vaccination discontinuation of primary prophylaxis after immune reconstitution treatment of disease monitoring for adverse effects during treatment management of treatment failure prevention of disease recurrence and discontinuation of secondary prophylaxis after immune reconstitution. The guidelines discuss opportunistic pathogens that occur in the United States and one that might be acquired during international travel (i.e., malaria). These guidelines are intended for use by clinicians and other health-care workers providing medical care for HIV-exposed and HIV-infected children in the United States.
This report updates and combines into one document earlier versions of guidelines for preventing and treating opportunistic infections (OIs) among HIV-exposed and HIV-infected children, last published in 20, respectively.
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