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.

Influenza

Last Updated: July 26, 2018; Last Reviewed: July 26, 2018

Panel's Recommendations
  1. Does influenza vaccination of children with HIV and their contacts decrease incidence or severity of influenza (compared with no vaccination)?
    • The prevention of influenza in children with HIV aged ≥6 months should include annual administration of inactivated influenza vaccine (either quadrivalent or trivalent, depending on availability) (strong, moderate).
    • Currently, it is suggested that children with HIV not receive live-attenuated influenza vaccinea (e.g., intranasal administered influenza vaccine, FluMist) (weak, very low).
    • Household members and close contacts (aged ≥6 months) of children with HIV should receive yearly influenza vaccine (any recommended and otherwise medically appropriate influenza vaccine) (strong, moderate).
  2. Does pre- or post-exposure antiviral chemoprophylaxis against influenza with a neuraminidase inhibitor in children with HIV prevent influenza and/or reduce morbidity (compared with no chemoprophylaxis)?
    • Pre-exposure antiviral chemoprophylaxis with a neuraminidase inhibitor against influenza may be considered in children with HIV with severe immunosuppression (i.e., CD4 T lymphocyte [CD4] cell percentage <15%) while influenza virus is circulating in the community, after careful consideration of risks and benefits as outlined in Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) and Infectious Diseases Society of America (IDSA) guidelines (weak, low).
    • Post-exposure antiviral chemoprophylaxis with a neuraminidase inhibitor against influenza is recommended in children with HIV with severe immunosuppression (i.e., CD4 percentage <15%), regardless of influenza vaccination status, if antiviral chemoprophylaxis can be started within 48 hours of exposure to an ill person with confirmed or suspected influenza (strong, moderate).
    • Post-exposure antiviral chemoprophylaxis with a neuraminidase inhibitor against influenza is recommended in children with HIV with moderate to no immunosuppression in whom influenza vaccination is contraindicated or unavailable (strong, moderate) or in seasons in which low influenza vaccine effectiveness is documented (strong, low), if antiviral chemoprophylaxis can be started within 48 hours of exposure to an ill person with confirmed or suspected influenza.
  3. Does antiviral treatment of children with HIV with diagnosed influenza decrease severity, morbidity, or complications of influenza (compared with no treatment)?
    • Children with HIV requiring hospitalization for laboratory-confirmed or clinically suspected influenza should receive antiviral treatment as soon as possible according to CDC/ACIP and IDSA guidelines. When influenza is suspected in the hospital setting, empiric antiviral treatment should be given without waiting for confirmatory laboratory testing and without regard to illness duration (strong, moderate). Antiviral treatment may provide benefit when started after 48 hours of illness onset in patients with severe, complicated, or progressive illness, and in hospitalized patients (weak, low).
    • Children with HIV in the outpatient setting with laboratory-confirmed or clinically suspected influenza should receive antiviral treatment as soon as possible (strong, moderate). Treatment should be initiated as early as possible regardless of influenza vaccine status and regardless of illness severity according to CDC/ACIP and IDSA guidelines.
    • In the outpatient setting, consideration could be given to withholding treatment if symptom duration exceeds 48 hours, the child has no HIV viremia or evidence of immunosuppression, is aged >5 years, and has no other underlying condition that places the child at high risk of complications from influenza (weak, low).

Rating System

Strength of Recommendation: Strong; Weak

Quality of Evidence: High; Moderate; Low; or Very Low

a As of the 2017–2018 influenza season, live attenuated influenza vaccine (LAIV) is not recommended by ACIP for any pediatric or adult patient given concerns about effectiveness. Please see the most recent ACIP statements regarding use of LAIV in future seasons.

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