New US guidelines for the prevention of opportunistic infections in people infected with HIV

The US Public Health Service and the Infectious Diseases Society of America have drawn up new Guidelines for the Prevention of Opportunistic Infections in Persons Infected with HIV. In the first update since 1999, the guidelines include new advice on drug interactions, screening for other viruses and prophylaxis treatment for OIs.

Major changes to the guidelines include:

  • The importance of screening all HIV-infected individuals for hepatitis C virus.
  • Additional information about transmission of human herpesvirus 8 infection.
  • New information on drug interactions, especially with regard to rifamycins and antiretroviral drugs.
  • Revised recommendations for immunization of HIV exposed/infected adults and children.

The new guidelines revise advice on prophylaxis. Higher ratings are provided for discontinuing primary prophylaxis for PCP and MAC when CD4+ T lymphocytes have increased to >200 cells/µL and >100 cells/µL respectively for three months in response to HAART.

They recommend discontinuing primary toxoplasmosis prophylaxis when the CD4+ T lymphocyte count has increased to >200 cells/µL for three months. Secondary PCP prophylaxis should be discontinued in patients whose CD4+ counts have increased to >200 cells/µL for three months, say the guidelines.

They now say secondary prophylaxis for disseminated MAC may be discontinued in patients with six months increase in CD4+ counts to >100 cells/µL. Secondary prophylaxis for toxoplasmosis and cryptococcosis may be discontinued in patients with sustained (at least six months) increase in CD4+ counts to >200 cells/µL and >100-200 cells/µL respectively.

Source: HIV/AIDS Treatment Service (HIVATIS)

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