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 documents are 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:

May 27, 2026

Community-Acquired Bacterial Pneumonia

• Updated the recommendations for preferred and alternative empiric treatment of community-acquired pneumonia (CAP).
• Added treatment recommendations for patients with CAP for whom a viral etiology is identified.
• Updated the recommendations on the use of corticosteroids in the management of CAP in hospitalized patients.

Hepatitis B Virus Infection

• Updated the recommendations for people with isolated anti–hepatitis B core antibody to reflect that tenofovir-sparing regimens can also be considered with monitoring of alanine aminotransferase.

Malaria

• Noted the potential for false-negative rapid diagnostic tests for Plasmodium falciparum due to emerging histidine-rich protein 2 gene deletions in some regions.
• Updated the medication options, dosing recommendations, and glucose-6-phosphate dehydrogenase deficiency screening requirements for anti-relapse therapy for P. vivax and P. ovale species infections.
• Updated the preferred treatment recommendations for pregnancy patients.

Mycobacterium avium Complex

• Clarified the use of molecular assays to identify Mycobacterium avium Complex (MAC) subspecies and mutations associated with macrolide resistance.
• Updated the guidance on diagnostic criteria and treatment for localized pulmonary MAC disease in keeping with the American Thoracic Society/European Respiratory Society/European Society of Clinical Microbiology and Infectious Diseases/Infectious Disease Society of America joint guideline on the treatment of nontuberculous mycobacterial pulmonary disease.
• Clarified the criteria for severe MAC disease that might require a third or fourth antimycobacterial drug for treatment.

Pneumocystis pneumonia

• Revised the recommendation statement regarding indications for initiating primary prophylaxis for Pneumocystis pneumonia for clarity and simplicity.

Syphilis

• Recommended serologic screening for syphilis in pregnant women at the first prenatal visit, at 28 weeks’ gestation, and at delivery.
• Noted that doxycycline post-exposure prophylaxis is an option for syphilis prevention for some individuals.

February 25, 2026

Immunizations for Preventable Diseases in Adults and Adolescents With HIV

• Adjusted the respiratory syncytial virus (RSV) vaccine guidance to reflect an expanded age range (50–74 years) for people with comorbid conditions and updated the recommendation rating.
• Updated the evidence summaries for herpes zoster, measles, varicella zoster, and COVID-19 vaccines; noted that people with advanced HIV may receive an additional dose of COVID-19 vaccine 6 months after their last dose.

Varicella-Zoster Virus Disease

• Updated the guidance for varicella post-exposure prophylaxis and treatment options for ocular manifestations of varicella-zoster virus disease.
• Updated the recommended period at which the varicella vaccine can be administered to people who have received antiviral post-exposure prophylaxis from >72 hours to >24 hours.