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.

Cryptosporidiosis

Last Updated: November 6, 2013; Last Reviewed: November 6, 2013

Panel's Recommendations for Cryptosporidiosis
Panel's Recommendations
  • Reduce risk of Cryptosporidium infection by avoiding drinking water from public swimming pools and other bodies of recreational water (AIII), touching farm animals (BIII), and having contact with known Cryptosporidium-infected individuals (AIII)
  • Combination antiretroviral therapy (cART) to prevent or reverse severe immune deficiency is the primary modality for preventing chronic Cryptosporidium infection in HIV-infected children (AII*).
  • Effective cART is the primary initial treatment for Cryptosporidium infections in HIV-infected children and adults (AII*)
  • Nitazoxanide can be considered in immunocompromised HIV-infected children in conjunction with cART for treatment of Cryptosporidium infection (BII*)
  • Supportive care with hydration, correction of electrolyte abnormalities, and nutritional supplementation should be provided (AIII).
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

Dosing Recommendations for Prevention and Treatment of Cryptosporidiosis
Preventive Regimen 
Indication First Choice Alternative Comments/Special Issues 
Primary Prophylaxis
ARV therapy to avoid advanced immune deficiency
N/A
 N/A

Secondary Prophylaxis
N/A N/A
 N/A

Treatment Effective cART:
  • Immune reconstitution may lead to microbiologic and clinical response
There is no consistently effective therapy for cryptosporidiosis in HIV-infected individuals; optimized cART and a trial of nitazoxanide can be considered.

Nitazoxanide (BI, HIV-Uninfected; BII*, HIV-Infected in Combination with Effective cART):
  • 1–3 years: Nitazoxanide (20 mg/mL oral solution) 100 mg orally twice daily with food
  • 4–11 years: Nitazoxanide (20 mg/mL oral solution) 200 mg orally twice daily with food
  • ≥12 years: Nitazoxanide tablet 500 mg orally twice daily with food

Treatment duration:
  • 3–14 days
Supportive Care:
  • Hydration, correct electrolyte abnormalities, nutritional support
Antimotility agents (such as loperamide) should be used with caution in young children.
Key to Acronyms: ARV = antiretroviral; cART = combination antiretroviral therapy

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