Update to the Guidelines for the Prevention and Treatment of Opportunistic Infections in Children With and Exposed to HIV
The Guidelines for the Prevention and Treatment of Opportunistic Infections in Children with and Exposed to HIV (Pediatric Opportunistic Infection Guidelines) have been updated.
Major revisions within the last six months are as follows:
- Updated areas impacted by Coccidioides spp.
- Recommended liposomal amphotericin as the preferred regimen for treatment of severe illness due to diffuse pulmonary or disseminated non-meningitic disease
- Added isavuconazole as an option for salvage therapy
- Updated indications and dosing recommendations for revaccination against hepatitis B virus (HBV)
- Updated recommended treatment options for HBV infection, including the addition of tenofovir alafenamide and the removal of interferon-alfa and adefovir
- Added screening recommendations for hepatocellular carcinoma
Figure 1. Recommended Immunization Schedule for Children With HIV Infection
- Added recommendations regarding immunizations for COVID-19, respiratory syncytial virus, dengue, and mpox
- Updated pneumococcal conjugate vaccine recommendations to include 15-valent and 20-valent pneumococcal conjugate (PCV15 and PCV20) vaccines
- Added catch-up immunization information for inactivated poliovirus vaccine (IPV)
- Added hepatitis A (HepA) vaccine and measles, mumps, and rubella (MMR) vaccine recommendations for international travelers
- Updated recommendations for meningococcal ACWY conjugate and B vaccines, including the addition of MenABCWY and removal of MenACWY-D
Immunizations for Preventable Diseases in Children and Adolescents With HIV
- Added table summarizing possible immunizations for children and adolescents with HIV
- Expanded discussion on postvaccination serology and revaccination
- Added information regarding human papillomavirus vaccination
- Updated recommendations on rotavirus vaccination in infants
- Added bedaquiline, imipanem/cilastatin, and isavuconazole
- Removed interferon-alfa-2b, pegylated interferon alfa-2a, and pegylated interferon alfa-2b
Table 5. Significant Drug Interactions for Drugs Used to Treat or Prevent Opportunistic Infections
- Added bedaquiline, isavuconazole, and ketoconazole
- Removed boceprevir, capreomycin, interferon-alfa, paromomycin, and telaprevir
All updates are developed by the subject matter groups listed in Appendix C of the guidelines and reviewed by editors and relevant outside reviewers before finalization.
For a list of recent updates, please see What's New in the Guidelines. To view or download the Guidelines for the Prevention and Treatment of Opportunistic Infections in Children with and Exposed to HIV, go to the Clinicalinfo website. The guidelines tables and recommendations also can be downloaded as separate PDF files.
Clinicalinfo welcomes your feedback on the latest revisions to the Guidelines for the Prevention and Treatment of Opportunistic Infections in Children with and Exposed to HIV. Please send your comments with the subject line “Pediatric Opportunistic Infections Guidelines” to HIVinfo@NIH.gov by June 19, 2025.