Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children
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: November 6, 2013; Last Reviewed: November 6, 2013
|Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials in children† with clinical outcomes and/or validated endpoints; I* = One or more randomized trials in adults with clinical outcomes and/or validated laboratory endpoints with accompanying data in children† from one or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; II = One or more well-designed, nonrandomized trials or observational cohort studies in children† with long-term outcomes; II* = One or more well-designed, nonrandomized trials or observational studies in adults with long-term clinical outcomes with accompanying data in children† from one or more similar nonrandomized trials or cohort studies with clinical outcome data; III = Expert opinion
†Studies that include children or children/adolescents, but not studies limited to post-pubertal adolescents
|Indication||First Choice||Alternative||Comments/Special Issues|
||Primary prophylaxis not routinely indicated in children.
||Fluconazole 6 mg/kg body weight (maximum 400 mg) by mouth once daily||Itraconazole 2–5 mg/kg body weight (maximum 200 mg) by mouth per dose twice daily||Lifelong secondary prophylaxis with fluconazole for patients with meningitis or disseminated disease in the immunocompromised patient is recommended. Secondary prophylaxis should be considered after treatment of milder disease if CD4 count remains <250 cells/mm3 or CD4 percentage <15%.|
|Treatment||Severe Illness with Respiratory Compromise due to Diffuse Pulmonary or Disseminated Non-Meningitic Disease:
||Severe Illness with Respiratory Compromise Due to Diffuse Pulmonary or Disseminated Non-Meningitic Disease (If Unable to Use Amphotericin):
Surgical debridement of bone, joint, and/or excision of cavitary lung lesions may be helpful.
Options should be discussed with an expert in the treatment of coccidioidomycosis.
||Meningeal Infection (Unresponsive to Fluconazole):
|Mild-to-Moderate Non-Meningeal Infection (e.g., Focal Pneumonia):
||Mild-to-Moderate Non-Meningeal Infection (e.g., Focal Pneumonia):
|Key to Acronyms: CD4 = CD4 T lymphocyte; IV = intravenous|