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:
 

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.

July 3, 2024

COVID-19

• Published a new section describing the approach to the prevention and management of COVID-19 in children with and exposed to HIV.
• Added recommendations for the use of pre-exposure prophylaxis, including COVID-19 vaccination in all children and the monoclonal antibody pemivibart in certain populations.

• Added recommendations for the treatment of COVID-19 with ritonavir-boosted nirmatrelvir, remdesivir, and/or corticosteroids, depending on the age of the child, clinical presentation, and risk factors for progression.