Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

What's New in the Guidelines

Updates to the 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 document is published in an electronic format that can be easily updated as relevant changes in prevention and treatment recommendations occur.

The editors and subject matter experts are committed to timely changes in this document because so 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 are also promptly posted). 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:

August 7, 2019

  1. Figure: Recommended Immunization Schedule for Adults and Adolescents with HIV Infection: The immunization table has been updated to reflect 2019 Advisory Committee on Immunization Practices (ACIP) recommendations, which include specific recommendations for people with HIV (PWH). Because the ACIP is silent on some issues related to newer vaccines, this section will be updated again shortly to provide additional recommendations from the Panel.

July 16, 2019

  1. Cryptosporidiosis: The Panel updated the Cryptosporidiosis section to reflect the availability of new diagnostic tests and data on the efficacy of available therapeutic agents. The updated text and references underscore the following:
    • The incidence of cryptosporidiosis in the United States is now <1 case per 1,000 person-years; however, outbreaks due to contamination of recreational water continue to be a public health issue. Individuals with HIV continue to have an increased risk of disease and should adhere to safe food and water practices, especially when traveling.
    • Multiplex molecular tests can identify a greater number of cases than microscopic methods.
    • Nitazoxanide, paromomycin, and spiramycin have some efficacy in patients with HIV receiving antiretroviral therapy (ART), but are not as effective in patients with severe immunosuppression; especially those not on ART. Among the three agents, nitazoxanide has shown the greatest efficacy, demonstrating a significant decrease in diarrhea and organism load in patients with HIV with CD4 counts >50 cells/mm3.

June 14, 2019

  1. Microsporidiosis: The Panel provided an update on the various microsporidia that have been documented in human infections and the correct taxonomy for these organisms, including the relationship of the microsporidia to the cryptomycota. The therapeutics section has been updated to include information on the availability of fumagillin for the treatment of Enterocytozoon bieneusi infection, including contact information for obtaining this medication from Sanofi. In addition, data on the use of nitazoxanide for the treatment of microsporidiosis is discussed. The reference section has been updated to include the authoritative textbook Microsporidia: Pathogens of Opportunity.

May 15, 2019

  • The name of the guidelines was updated to include People-First Language. People-First Language is a way of reducing stigma and showing respect for individuals who are living with HIV by focusing on the person instead of the disease. The new title is Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV.
  • The sections about opportunistic infections were alphabetized to make it easier to navigate the guidelines.
  • The information in Tables 1, 2, and 4 were also alphabetized by opportunistic infection name.
  • The name of the Isosporiasis section was updated to Cystoisosporiasis.
  • The name of the Penicilliosis section was updated to Talaromycosis.
  • The Preventing Exposures section was removed from the current guidelines. This section can be found in the archived versions of the guidelines.

March 28, 2019

  1. Pneumocystis Pneumonia: The Panel updated references for stopping PCP prophylaxis in patients with CD4 counts between 100 and 200 cells/mm3 and plasma viral loads below the detection limits of assays. The Panel also updated references for Pneumocystis-associated IRIS. Wording throughout the document was updated to improve clarity.

February 15, 2019

  1. Disseminated Mycobacterium avium Complex Disease: The Panel updated the text and references throughout the section and made two key changes to their guidance:
    • Primary prophylaxis for MAC in people living with HIV who immediately initiate antiretroviral therapy is no longer recommended, regardless of CD4 cell count.
    • Guidance has been added about drug-drug interactions and dosing when using rifabutin for treatment or prevention of MAC together with newer non-nucleoside reverse transcriptase inhibitors (rilpivirine, doravirine) and integrase strand transfer inhibitors (elvitegravir/cobicistat, bictegravir).

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