U.S. Releases Updated Clinical Guidelines for HIV-Associated Opportunistic Infections

The first complete update in five years of the U.S. guidelines for preventing and treating HIV-associated opportunistic infections has been released by the National Institutes of Health and the Centers for Disease Control and Prevention in cooperation with the HIV Medicine Association of the Infectious Diseases Society of America (IDSA).

The new Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents apply state-of-the-art science and medicine to 29 infectious diseases of concern. More than 140 medical experts contributed their knowledge to this edition of the guidelines, released on April 10.

"The scientific community has developed new and more accurate diagnostic tests for HIV-associated opportunistic infections during the past five years, more effective treatments for these infections and better approaches to preventing them," says Henry Masur, M.D., co-chair of the working group that revised the guidelines, chief of the Critical Care Medicine Department in the NIH clinical research hospital and a former president of IDSA. "The updated guidelines outline these advances for physicians and patients across the United States and beyond."

HIV cripples the immune systems of its human hosts, leaving them more vulnerable than the general population to numerous other infectious diseases. These HIV-associated opportunistic infections are a leading cause of hospitalization and death among HIV-infected individuals in the United States.

"Although the incidence rate of HIV-associated opportunistic infections has declined dramatically in the United States, primarily due to advances in antiretroviral therapy, these infections continue to threaten the health of many people infected with HIV," says John T. Brooks, M.D., co-author of the guidelines and leader of the HIV Clinical Epidemiology Team in CDC’s Division of HIV/AIDS Prevention. "It is critical that health care providers, especially newer clinicians who may have less experience with opportunistic infections, remain able to recognize the signs and symptoms of these infections and know how to provide the most effective preventive care and treatment."

The new guidelines combine what were previously two separate publications, one for the prevention of opportunistic infections (last published in 2002) and one for their treatment (first published in 2004).

Major changes to the guidelines include

• Emphasis on the important role of effective antiretroviral therapy in augmenting immune function, which is pivotal to preventing and managing opportunistic infections
• Information on the diagnosis and management of immune reconstitution inflammatory syndrome, a condition in which the immune system begins to recover, but then responds to a previously acquired opportunistic infection with an overwhelming inflammatory response that worsens the symptoms of infection
• Information on the prevention and treatment of hepatitis B and C infections
• Information on interferon-gamma release assays for the detection of latent Mycobacterium tuberculosis infection
• Updated information on interactions between antiretroviral drugs and drugs used to treat opportunistic infections
• A new section on malaria and other tropical diseases that may become opportunistic infections in HIV-infected immigrants to the United States and in HIV-infected American travelers

HIV-associated opportunistic infections in the United States often occur in people who are unaware that they have HIV; in such cases, the opportunistic infection may be the first sign of late-stage HIV disease. HIV-associated opportunistic infections also tend to occur among Americans who are aware of their HIV infection but are not receiving treatment for it, who do not or cannot take antiretroviral therapy, who take antiretroviral therapy but fail to benefit from it, or who do not receive needed preventive care for an opportunistic infection.

A draft of the new guidelines was released in June 2008 for public comment, and an early edition of the new guidelines was published online on March 24. View the finalized new Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. These guidelines, as well as all federal HIV prevention and treatment guidelines, can be found on the AIDSInfo Web site.

A final draft of the corresponding pediatric version of these guidelines, Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-Exposed and HIV-Infected Children, is under review and will be published later this year.