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:

August 15, 2024

Mycobacterium avium Complex

• Updated information to prioritize the initiation of effective antiretroviral therapy and to refrain from primary prophylaxis for Mycobacterium avium Complex (MAC) except for people with HIV who are not receiving ART, remain viremic on ART, or have no options for a fully suppressive ART regimen.
• Added new information indicating that drugs demonstrating substantive in vitro activity against MAC might be considered for the treatment of refractory MAC disease (e.g., bedaquiline, tedizolid, linezolid, omadacycline), acknowledging that there is insufficient observational or clinical trial data to support formal recommendations in this setting.
• Updated information on drug–drug interactions between anti-MAC therapies, particularly rifabutin, and antiretroviral drugs and provided a link to the Adult and Adolescent Antiretroviral Guidelines on drug–drug interactions.

July 29, 2024

Leishmaniasis

• Updated information on prevalence, including transmission in the United States.
• Updated information on the use of polymerase chain reaction, or PCR, and serological tests for the diagnosis of leishmanial diseases.
• Updated treatment regimens for each of the leishmanial diseases, including regimens that reduce the likelihood of recurrence.
• Added new information about special considerations in pregnancy.

July 9, 2024

Human Papillomavirus

• A brief summary of this update is available here from the NIH Office of AIDS Research.
• Based on the ANCHOR study results, provided new screening and treatment recommendations for anal cancer prevention.
• Provided new anal cancer screening algorithms.

May 2, 2024

Mycobacterium tuberculosis

• Recommended a 4-month regimen of daily rifapentine, isoniazid, pyrazinamide, and moxifloxacin as an alternative treatment for active pulmonary tuberculosis (TB) in people receiving efavirenz-based antiretroviral therapy.
• Recommended a regimen consisting of bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) as the preferred treatment for rifampin-resistant TB.