Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV

The Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV document is published in an electronic format and updated as relevant changes in prevention and treatment recommendations occur.

All changes are developed by the subject-matter groups listed in the document. (Changes in group composition also are posted promptly.) These changes are reviewed by the editors and relevant outside reviewers before the document is altered. Major revisions within the last 6 months are as follows:

April 23, 2025

Cystoisosporiasis (Formerly Isosporiasis)

• Updated the epidemiology information, including adding new regions endemic for Cystoisospora belli.
• Updated the diagnosis section, including new information on the use of polymerase chain reaction, or PCR, for diagnosing cystoisosporiasis.
• Provided more detailed recommendations regarding the use of primary prophylaxis.
• Updated preferred and alternative regimens for treatment and chronic maintenance therapy.

Human Herpesvirus-8 Disease

• Provided more detailed information on diagnosing diseases associated with human herpesvirus-8 (HHV-8).
• Updated recommended treatment regimens for Kaposi sarcoma (KS), multicentric Castleman’s disease, primary effusion lymphoma, and HHV-8 diffuse large B-cell lymphoma.
• Added information on the treatment of KS inflammatory cytokine syndrome.

Table 6

• Updated to incorporate clinical discretion when adjusting doses of lamivudine and emtricitabine for renal insufficiency, now aligning with dosing recommendations found in the Adult and Adolescent Antiretroviral Guidelines from the U.S. Department of Health and Human Services.

December 16, 2024

Hepatitis B Virus

• Recommended Heplisav-B as the preferred vaccine for all adults with HIV, including those who are vaccine naive or prior vaccine nonresponders.
• Included a new section on considerations of nucleos(t)ide-sparing regimens in people with past hepatitis B virus (HBV), chronic HBV, and isolated hepatitis B core antibody positivity.
• Changed the consideration for pegylated interferon to an alternative treatment used only in rare cases.
• Removed PreHevbrio since it no longer will be available in the United States.

November 12, 2024

Immunizations

• Updated COVID-19 and influenza recommendations with new information on current vaccine formulations and data supporting their use.
• Provided new recommendations for the use of respiratory syncytial virus (RSV) vaccines including data supporting their use.
• Updated HepBCpG (Heplisav-B) to the preferred hepatitis B vaccine for people with HIV.
• Added pentavalent meningococcal conjugate vaccine (MenABCWY) recommendations as an alternative to separate administration of quadrivalent meningococcal vaccine and meningococcal group B vaccine.

October 29, 2024

Coccidioidomycosis

• Added isavuconazole sulfate as an alternative treatment for mild-to-moderate pulmonary infections.
• Updated the recommended fluconazole dosing for treatment of coccidioidal meningitis.
• Updated information and recommendations on the use of azole antifungals during pregnancy.

Cryptococcosis

• Updated alternative regimens for induction, consolidation, and maintenance therapy and recommendations on the timing and frequency of lumbar punctures for central nervous system and/or disseminated disease.
• Updated the recommended fluconazole dosing for the treatment of focal pulmonary infiltrates and isolated cryptococcal antigenemia.
• Provided more detailed recommendations for treatment during pregnancy.

Histoplasmosis

• Added alternative maintenance therapy regimens for treatment of severe disseminated disease.
• Updated information on the importance of monitoring serum concentration levels for itraconazole and voriconazole.