Guidelines for the Prevention and Treatment of Opportunistic Infections in Children With and Exposed to HIV

The Guidelines for the Prevention and Treatment of Opportunistic Infections in Children With and Exposed to HIV (Pediatric Opportunistic Infection Guidelines) 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 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:

June 05, 2025

Coccidioidomycosis

• Updated areas impacted by Coccidioides spp.
• Recommended liposomal amphotericin as the preferred regimen for treatment of severe illness due to diffuse pulmonary or disseminated non-meningitic disease.
• Added isavuconazole as an option for salvage therapy.

Hepatitis B Virus Infection

• Updated indications and dosing recommendations for revaccination against hepatitis B virus (HBV).
• Updated recommended treatment options for HBV infection, including the addition tenofovir alafenamide and the removal of interferon-alfa and adefovir.
• Added screening recommendations for hepatocellular carcinoma.

Figure 1. Recommended Immunization Schedule for Children With HIV Infection

• Added recommendations regarding immunizations for COVID-19, respiratory syncytial virus, dengue, and mpox.
• Updated pneumococcal conjugate vaccine recommendations to include 15-valent and 20-valent pneumococcal conjugate (PCV15 and PCV20) vaccines.
• Added catch-up immunization information for inactivated poliovirus vaccine (IPV).
• Added hepatitis A (HepA) vaccine and measles, mumps, and rubella (MMR) vaccine recommendations for international travelers.
• Updated recommendations for meningococcal ACWY conjugate and B vaccines, including adding MenABCWY and removing MenACWY-D.

Immunizations for Preventable Diseases in Children and Adolescents With HIV

• Added table summarizing possible immunizations for children and adolescents with HIV.
• Expanded discussion on postvaccination serology and revaccination.
• Added information regarding human papillomavirus vaccination.
• Updated recommendations on rotavirus vaccination in infants.

Table 4. Common Drugs Used for Treatment of Opportunistic Infections in Children With HIV: Preparations and Major Toxicities

• Added bedaquiline, imipanem/cilastatin, and isavuconazole.
• Removed interferon-alfa-2b, pegylated interferon alfa-2a, and pegylated interferon alfa-2b.

Table 5. Significant Drug Interactions for Drugs Used to Treat or Prevent Opportunistic Infections

• Added bedaquiline, isavuconazole, and ketoconazole.
• Removed boceprevir, capreomycin, interferon-alfa, paromomycin, and telaprevir.
   

November 21, 2024

Bacterial Infections

• Updated the literature for bacterial infections in children with HIV and children who were exposed to HIV but not infected, including epidemiology, infection risk and vaccine recommendations.

• Added vaccine recommendations for the use of pneumococcal vaccines PCV15, PCV20, and PPSV23 in children with HIV.

• Updated recommendations for the diagnostics and management of bacterial infections with considerations made for newer technology (including molecular testing), antimicrobial stewardship, and changes in relevant treatment guidelines.

Hepatitis C Virus Infection

• Recommended hepatitis C virus (HCV) RNA testing for infants between 2 to 6 months with perinatal HCV exposure.

• Added information and recommendations supporting the use of pangenotypic direct-acting antivirals (DAAs) in children aged 3 years and older. 

• Noted treatment for HCV during pregnancy can be considered with shared decision-making.