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.

Human Herpesvirus 8 Disease

Last Updated: December 15, 2016; Last Reviewed: December 15, 2016

Panel's Recommendations for Human Herpesvirus 8 Disease
Panel's Recommendations
  1. Is there an indication for serologic testing for human herpesvirus 8 (HHV-8) in asymptomatic HIV-infected children (compared with not testing) to guide clinical management?
    Antibody (or DNA testing) for HHV-8 is insufficiently sensitive/specific to predict risk of Kaposi sarcoma. Therefore, routine testing to identify HHV-8-seropositive, HIV-infected patients is not recommended (strong, very low).

  2. Among HIV-infected children, does initiation of antiretroviral therapy (ART) (as compared with non-initiation) reduce the risk of Kaposi sarcoma? 
    Effective suppression of HIV replication with ART is recommended to reduce the risk of  HHV-8-associated Kaposi sarcoma (strong, low).

  3. For HIV-infected patients initiating ART, are any specific ART regimens associated with lower rates of Kaposi sarcoma?
    Data are insufficient and conflicting upon which to base a recommendation for a particular ART regimen for prevention of Kaposi sarcoma (weak, low).

  4. Among HIV-infected children with active Kaposi sarcoma, is treatment with ART (as compared with no ART) associated with higher rates of remission and/or decreased mortality?
    Treatment with ART is associated with increased survival among HIV-infected children with active Kaposi sarcoma. Effective suppression of HIV replication with ART is recommended for all patients with evidence of active Kaposi sarcoma and other HHV-8-associated malignant lymphoproliferative disorders (strong, very low)

  5. Among HIV-infected children with active Kaposi sarcoma, is treatment with chemotherapy in addition to ART (as compared with ART alone) associated with higher rates of remission and/or decreased mortality?
    Systemic chemotherapy, in addition to ART, is associated with higher rates of remission and decreased mortality and is recommended for disseminated or visceral Kaposi sarcoma (stage T1 disease) and for primary effusion lymphoma (strong, low). For localized Kaposi sarcoma (stage T0 disease), the benefit of systemic chemotherapy (in addition to ART) is unclear.

  6. Among HIV-infected children treated with ART who develop immune reconstitution inflammatory syndrome (IRIS), is chemotherapy in addition to continuation of ART (compared with no chemotherapy) associated with higher rates of remission and/or decreased mortality?
    For patients with Kaposi-sarcoma-associated IRIS, chemotherapy along with continuation of ART is recommended (strong, low).

  7. Among HIV-infected children who achieve remission from Kaposi sarcoma, what therapies are recommended to lower the risk of recurrence?
    Effective suppression of HIV replication with ART in HIV-infected patients with Kaposi sarcoma may prevent Kaposi sarcoma progression or occurrence of new lesions and may decrease risk of recurrence after remission. Life-long ART is recommended for all individuals with evidence of active or treated Kaposi sarcoma or other HHV-8-associated malignant lymphoproliferative disorders (strong, low).
Rating System 
Strength of Recommendation: Strong; Weak
Quality of Evidence: High; Moderate; Low; or Very Low

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