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:

July 8, 2013

• Cytomegalovirus (CMV) Disease: In May 2013, the ganciclovir ocular implant ceased to be marketed in the United States. As a result, recommendations for the treatment of CMV retinitis have been modified (pages N1 through N15 of the document). These recommendations emphasize treatment of CMV retinitis with antiretroviral therapy, oral valganciclovir, oral or intravenous ganciclovir, intravenous foscarnet, and (for certain lesions) intraocular ganciclovir injections. These recommendations are based on the best information and advice available in 2013; in the era of effective and durable antiretroviral therapy and the era when oral valganciclovir is available rather than oral ganciclovir, there has been a paucity of adequately powered studies of therapy of CMV retinitis.
• Varicella Zoster Disease: Recommendations on pages O7 through O14 for the treatment of progressive outer retinal necrosis have been revised because the ganciclovir ocular implants ceased to be marketed in the United States in May 2013. These recommendations still emphasize the use of combination intravenous therapy, but the focus has been changed from intraocular ganciclovir implants to intravitreal drug injections.

Table 2 and Table 4 were updated to reflect the updates.

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