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:

July 14, 2025

Cytomegalovirus Disease

• Expanded the discussion on the diagnosis and treatment of non-ocular cytomegalovirus end-organ disease.
• Updated guidance on monitoring response to therapy and drug adverse effects.

Herpes Simplex Virus

• Provided more detailed information on diagnosing diseases associated with human herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2).
• Added recommendations on the management of HSV epithelial keratitis and stromal keratitis.
• Added treatment recommendations for central nervous system, visceral, and disseminated HSV-1 and HSV-2 disease.

Immunizations for Preventable Diseases in Adults and Adolescents With HIV

• Updated pneumococcal vaccine recommendations to include the use of 21-pneumococcal conjugate vaccine (PCV21).
• Updated mpox vaccine recommendations with new information on data supporting their use.
• Added a second pentavalent meningococcal conjugate vaccine (MenABCWY) recommendation and updated the dosing intervals for meningococcal group B vaccines.

Mpox

• Updated treatment recommendations to reflect new trial data suggesting limited benefit of tecovirimat monotherapy; clarified eligibility for use under an expanded-access investigational new drug protocol.

Table 4: Significant Pharmacokinetic Interactions Between Drugs Used to Treat or Prevent Opportunistic Infections

• Expanded the discussion on rifamycin- and azole-related interactions, as well as therapeutic drug monitoring.

Talaromycosis (Formerly Penicilliosis)

• Updated and expanded the Diagnosis section, with a focus on non–culture-based diagnostics.
• Provided more detailed recommendations regarding the use of primary prophylaxis.

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.