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.


Last Updated: March 28, 2017; Last Reviewed: June 26, 2019

Recommendations for Preventing and Treating Malaria
Preventing Malaria in Patients Traveling to Endemic Areas:
  • Recommendations are the same for HIV-infected and HIV-uninfected patients.
  • Specific recommendations are based on region of travel, malaria risks, and drug susceptibility in the region.
  • Clinicians should refer to the following website for the most up-to-date recommendations:
  • TMP-SMX has been shown to reduce malaria in HIV-infected adults in Africa. However, it is not as effective as antimalarial prophylactic regimens. Therefore, HIV-infected travelers should not rely on TMP-SMX for prophylaxis against malaria (AIII).
Treating Malaria
  • Because Plasmodium falciparum malaria can progress within hours from mild symptoms or low-grade fever to severe disease or death, all HIV-infected patients with confirmed or suspected P. falciparum infection should be admitted to the hospital for evaluation, initiation of treatment, and observation of response to therapy (AIII).
  • When suspicion of malaria is low, antimalarial treatment should not be initiated until the diagnosis has been confirmed by laboratory investigations.
  • Treatment should not be delayed when malaria is strongly suspected but laboratory services are unavailable or results will be delayed (AIII).
  • When malaria is strongly suspected, but not yet confirmed, clinicians are advised to consider and initiate treatment for other possible diagnoses in addition to malaria.
  • Treatment recommendations for HIV-infected patients are the same as HIV-uninfected patients (AIII).
  • Choice of therapy is guided by the degree of parasitemia, the species of Plasmodium, the patient’s clinical status, and the likely drug susceptibility of the infected species.
  • For treatment recommendations for specific region, clinicians should refer to
    • The CDC malaria website:
    • The CDC Malaria Hotline: (770) 488-7788; Monday through Friday. 8 a.m. to 4:30 p.m. EST. (770) 488-7100 after hours.

Key to Acronyms: CDC = the Centers for Disease Control and Prevention; TMP-SMX = Trimethoprim-sulfamethoxazole

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