Updated Guidelines for HIV-Associated Opportunistic Infections Released

The new guidelines combine what were previously two separate publications, one for the prevention of opportunistic infections (last published in 2002) and one for their treatment (first published in 2004).

Major changes to the guidelines include:

-- Emphasis on the important role of effective antiretroviral therapy in augmenting immune function, which is pivotal for preventing and managing opportunistic infections

-- Information on the diagnosis and management of immune reconstitution inflammatory syndrome, a condition in which the immune system begins to recover, but then responds to a previously acquired opportunistic infection with an overwhelming inflammatory response that worsens the symptoms of infection

-- Information on the prevention and treatment of hepatitis B and C infections

-- Information on interferon-gamma release assays for the detection of latent Mycobacterium tuberculosis infection

-- Updated information on interactions between antiretroviral drugs and drugs used to treat opportunistic infections

-- A new section on malaria and other tropical diseases that may become opportunistic infections in HIV-infected immigrants to the United States and in HIV-infected American travelers

HIV-associated opportunistic infections in the United States often occur in people who are unaware that they have HIV; in such cases, the opportunistic infection may be the first sign of late-stage HIV disease. HIV-associated opportunistic infections also tend to occur among Americans who are aware of their HIV infection but are not receiving treatment for it, who do not or cannot take antiretroviral therapy, who take antiretroviral therapy but fail to benefit from it, or who do not receive needed preventive care for an opportunistic infection.

A draft of the new guidelines was released in June 2008 for public comment, and an early edition of the new guidelines was published online on March 24. The finalized new Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents are accessible at http://www.cdc.gov/mmwr/pdf/rr/rr5804.pdf and http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5804a1.htm. These guidelines, as well as all federal HIV prevention and treatment guidelines, can be found on the AIDSInfo Web site at http://www.aidsinfo.nih.gov/Guidelines/Default.aspx?MenuItem=Guidelines.

A final draft of the corresponding pediatric version of these guidelines, Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-Exposed and HIV-Infected Children, is under review and will be published later this year.

Reference: Centers for Disease Control and Prevention. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. MMWR 58 (No. RR-4):1-207 (2009).