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.

September 14, 2023

Mycobacterium tuberculosis

• Added recommendations for dolutegravir- and raltegravir-based antiretroviral (ARV) regimens in the context of tuberculosis (TB) disease for children >20 kg and <20 kg, respectively. 
• Added references to American Academy of Pediatrics (AAP) guidance that recommends interferon-gamma release assays (IGRAs) to diagnose latent tuberculosis infection (LTBI) in children ≥2 years old.
• Added recommendations that children ≥2 years old with HIV infection who are receiving ARV regimens with acceptable drug-drug interactions with rifapentine can receive the 12-dose isoniazid-rifapentine LTBI treatment regimen. 

August 3, 2023

Introduction

• Summarized key changes resulting from a rescoping consultation for the Pediatric Opportunistic Infection Guidelines in 2021 to better address the current needs of clinicians caring for children with and exposed to HIV.
• Updated the context and description for the use of the previous and new evidence rating systems.
• Combined the previous Summary and the Background and Recommendations Rating Scheme sections into a single Introduction section to streamline essential information and consolidate reference tools in one accessible location.

Cytomegalovirus

• Added a recommendation to test infants exposed to HIV for congenital cytomegalovirus (CMV) infection due to high rates of CMV transmission among newborns with and exposed to HIV.
• Harmonized congenital CMV treatment recommendations for infants with HIV to match those for children without HIV based on American Academy of Pediatrics Red Book guidelines.