Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

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.

What's New in the Guidelines

Updates to the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

The Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents document was published in an electronic format that could be easily updated as relevant changes in prevention and treatment recommendations occur.

The editors and subject matter experts are committed to timely changes in this document because so many health care providers, patients, and policy experts rely on this source for vital clinical information.

All changes are developed by the subject matter groups listed in the document (changes in group composition are also promptly posted). These changes are reviewed by the editors and by relevant outside reviewers before the document is altered. Major revisions within the last 6 months are as follows:

March 28, 2019

  1. Pneumocystis Pneumonia: The Panel updated references for stopping PCP prophylaxis in patients with CD4 counts between 100 and 200 cells/mm3 and plasma viral loads below the detection limits of assays. The Panel also updated references for Pneumocystis-associated IRIS. Wording throughout the document was updated to improve clarity.

February 15, 2019

  1. Disseminated Mycobacterium avium Complex Disease: The Panel updated the text and references throughout the section and made two key changes to their guidance:
    • Primary prophylaxis for MAC in people living with HIV who immediately initiate antiretroviral therapy is no longer recommended, regardless of CD4 cell count.
    • Guidance has been added about drug-drug interactions and dosing when using rifabutin for treatment or prevention of MAC together with newer non-nucleoside reverse transcriptase inhibitors (rilpivirine, doravirine) and integrase strand transfer inhibitors (elvitegravir/cobicistat, bictegravir).

November 29, 2018

  1. Human Papillomavirus Disease: The Panel updated the recommendation on HPV vaccination in females and males with HIV infection ages 13 to 26 years to the 9-valent HPV recombinant vaccine (0.5 ml at 0, 1 to 2, and 6 months) (AIII). For patients who have completed a vaccination series with the recombinant bivalent or quadrivalent vaccines, many experts would give an additional full series of the 9-valent recombinant vaccine (CIII).

November 13, 2018

  1. Hepatitis B Virus Infection: The Panel added information regarding the recently approved two-dose hepatitis B vaccine conjugated to a TLR9 agonist (Heplisav-B). Since there are no data on this vaccine in individuals with HIV, we present it as an option with a CIII recommendation. The Panel added recommendations regarding considerations to prevent HBV reactivation during immunosuppressive therapy in patients with HBsAg-negative/anti-HBc positive disease: Starting tenofovir/emtricitabine backbone when possible with other options presented if this cannot be given.
  2. Progressive Multifocal Leukoencephalopathy/JC Virus Infection: The section was updated to reflect current information about the value of plasma PCR and to include updated references on failed therapies.

Download Guidelines