What's New in the Guidelines

Updated
Reviewed
Oct. 13, 2021

Updates to the 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 that can be updated easily as relevant changes in prevention and treatment recommendations occur.

The editors and subject-matter experts are committed to timely changes in this document because so many health care providers, patients, and policy experts rely on this source for vital clinical information.

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 by relevant outside reviewers before the document is altered. Major revisions within the last 6 months are as follows:

What’s New

November 18, 2021

Key updates to the guidelines include the following:

Appendix B: Panel Roster and Financial Disclosures

  • Updated member conflict of interest information for 2021-2022.
  • Updated roster to include 22 new members, 6 new Section Group Leads and 1 new Leadership member.

Immunizations

  • The immunizations section has been updated to reflect the recommendation that all people with HIV should receive the COVID-19 vaccine regardless of their CD4 T lymphocyte count or HIV viral load.
  • People with advanced or untreated HIV who received a 2-dose series with one of the mRNA COVID-19 vaccines should receive a third dose of that vaccine at least 28 days after the second dose.
  • The zoster vaccine is now recommended for people with HIV age 18 years old and older in alignment with Advisory Committee on Immunization Practices (ACIP) recommendations. 

August 18, 2021

Human Papillomavirus Disease: Key updates to the guidelines include the following:

  • New recommendation for cervical cancer screening to start at age 21 based on the HIV/AIDS Cancer Match Study with no reported cases of cervical cancer below the age of 25.

July 21, 2021

Varicella-Zoster Virus Disease: Key updates to the guidelines include the following:

  • Updated to reflect that recombinant zoster vaccine (RZV, Shingrix) is the only available vaccine for prevention of shingles in the United States. As of November 18, 2020, attenuated zoster vaccine live (ZVL, Zostavax) is no longer available for use in the United States.

July 1, 2021

Cytomegalovirus: Key updates to the guidelines include the following:

  • Updated to improve readability and to update references.
  • The toxicities of alternative antiviral medications used to treat cytomegalovirus are highlighted.
  • The document was updated for person-first language.

Cryptococcosis: Key updates to the guidelines include the following:

  • Recommended an increase in the dose of fluconazole from 400 mg to 800 mg daily for consolidation therapy. For clinically stable patients who have been started on ART and whose CSF culture results return with no growth, the dose can be decreased to 400 mg daily.
  • Included results of a trial in a resource-limited setting that used only one week of amphotericin B induction therapy but did NOT recommend this approach for high-resource settings.
  • Clarified that the treatment of non-CNS extrapulmonary cryptococcosis and diffuse pulmonary disease should be the same as that for meningitis and that treatment of mild-moderate focal pulmonary infection should be with fluconazole, 400-800 mg daily.
  • Clarified treatment for patients who have been found to have asymptomatic antigenemia. 
  • Revised the Pregnancy text for consistency with other sections of the guidelines.
  • Revised the table of recommendations to clarify recommended treatment of the various forms of cryptococcosis in persons with HIV.

June 11, 2021

  1. Coccidioidomycosis: Key updates to the guidelines include the following:
    • Revised section on serology for the diagnosis of coccidioidomycosis.
    • Added polymerase chain reaction (PCR) as a commercially available diagnostic test.
    • Revised the section on patients who are asymptomatic and have a positive serological test.
  2. Bartonellosis: Key updates to the guidelines include the following:
    • Updated the section on diagnostics, including role of PCR-based testing.
    • Updated the section on treatment for endocarditis.
  3. Immunizations for Preventable Diseases in Adults and Adolescents Living with HIV: Key updates to the guidelines include the following:
    • Revised the figure summarizing immunizations in people with HIV.
    • Added table comparing ACIP recommendations with Panel recommendations.
    • Added narrative sections with evidence summaries.
    • Updated the recommendation for zoster vaccines.

Updates to the 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 that can be updated easily as relevant changes in prevention and treatment recommendations occur.

The editors and subject-matter experts are committed to timely changes in this document because so many health care providers, patients, and policy experts rely on this source for vital clinical information.

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 by relevant outside reviewers before the document is altered. Major revisions within the last 6 months are as follows:

What’s New

November 18, 2021

Key updates to the guidelines include the following:

Appendix B: Panel Roster and Financial Disclosures

  • Updated member conflict of interest information for 2021-2022.
  • Updated roster to include 22 new members, 6 new Section Group Leads and 1 new Leadership member.

Immunizations

  • The immunizations section has been updated to reflect the recommendation that all people with HIV should receive the COVID-19 vaccine regardless of their CD4 T lymphocyte count or HIV viral load.
  • People with advanced or untreated HIV who received a 2-dose series with one of the mRNA COVID-19 vaccines should receive a third dose of that vaccine at least 28 days after the second dose.
  • The zoster vaccine is now recommended for people with HIV age 18 years old and older in alignment with Advisory Committee on Immunization Practices (ACIP) recommendations.

August 18, 2021

Human Papillomavirus Disease: Key updates to the guidelines include the following:

  • New recommendation for cervical cancer screening to start at age 21 based on the HIV/AIDS Cancer Match Study with no reported cases of cervical cancer below the age of 25.

July 21, 2021

Varicella-Zoster Virus Disease: Key updates to the guidelines include the following:

  • Updated to reflect that recombinant zoster vaccine (RZV, Shingrix) is the only available vaccine for prevention of shingles in the United States. As of November 18, 2020, attenuated zoster vaccine live (ZVL, Zostavax) is no longer available for use in the United States.

July 1, 2021

Cytomegalovirus: Key updates to the guidelines include the following:

  • Updated to improve readability and to update references.
  • The toxicities of alternative antiviral medications used to treat cytomegalovirus are highlighted.
  • The document was updated for person-first language.

Cryptococcosis: Key updates to the guidelines include the following:

  • Recommended an increase in the dose of fluconazole from 400 mg to 800 mg daily for consolidation therapy. For clinically stable patients who have been started on ART and whose CSF culture results return with no growth, the dose can be decreased to 400 mg daily.
  • Included results of a trial in a resource-limited setting that used only one week of amphotericin B induction therapy but did NOT recommend this approach for high-resource settings.
  • Clarified that the treatment of non-CNS extrapulmonary cryptococcosis and diffuse pulmonary disease should be the same as that for meningitis and that treatment of mild-moderate focal pulmonary infection should be with fluconazole, 400-800 mg daily.
  • Clarified treatment for patients who have been found to have asymptomatic antigenemia. 
  • Revised the Pregnancy text for consistency with other sections of the guidelines.
  • Revised the table of recommendations to clarify recommended treatment of the various forms of cryptococcosis in persons with HIV.

June 11, 2021

  1. Coccidioidomycosis: Key updates to the guidelines include the following:
    • Revised section on serology for the diagnosis of coccidioidomycosis.
    • Added polymerase chain reaction (PCR) as a commercially available diagnostic test.
    • Revised the section on patients who are asymptomatic and have a positive serological test.
  2. Bartonellosis: Key updates to the guidelines include the following:
    • Updated the section on diagnostics, including role of PCR-based testing.
    • Updated the section on treatment for endocarditis.
  3. Immunizations for Preventable Diseases in Adults and Adolescents Living with HIV: Key updates to the guidelines include the following:
    • Revised the figure summarizing immunizations in people with HIV.
    • Added table comparing ACIP recommendations with Panel recommendations.
    • Added narrative sections with evidence summaries.
    • Updated the recommendation for zoster vaccines.

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