New NIH guidelines for managing opportunistic infections in children with HIV

Published on November 27, 2013 at 8:26 AM · No Comments

Sharon Nachman, MD, a pediatric HIV and infectious diseases specialist at Stony Brook Children's Hospital, is a co-author of new National Institutes of Health (NIH)-issued guidelines for the prevention, treatment and management of opportunistic infections in HIV-exposed and HIV-infected children. The 2013 guidelines shed light on the most effective way to treat dangerous and deadly infections such as pneumonia or tuberculosis that can strike immunosuppressed pediatric HIV patients.

December 1 is World AIDS Day, an annual day of commemoration in the fight against HIV/AIDS. Dr. Nachman, Associate Dean for Research, Professor of Pediatrics, and Chief of Pediatric Infectious Diseases at Stony Brook University School of Medicine, joined an international panel of pediatric HIV infection and infectious diseases specialists to develop the new Guidelines, which were previously published in 2009. See this NIH summary and link to the full Guidelines.

"Treatment of opportunistic infections is an evolving science, therefore we need to assess the latest clinical data, treatment options and the current infectious disease climate to maximize the prevention, treatment and management of these infections in this vulnerable population," said Dr. Nachman. "There are a host of changes in these guidelines that will help HIV specialists worldwide to reduce opportunistic infections in HIV-exposed and infected children."

Dr. Nachman said that the 2013 guidelines place a greater emphasis on the importance of antiretroviral therapy (ART) for the prevention and treatment of opportunistic infections, especially for those types of infections for which no specific therapy exists. A subsection on potential drug-drug interactions with ART is also updated.

She added that a new set of recommendations on increased information about the diagnosis and management of immune reconstitution syndrome (IRIS), a situation in which patients have an exaggerated immune reaction to the treatment for the opportunistic infection itself, will be invaluable to pediatric HIV specialists. One key component of this section are updated recommendations on discontinuation of opportunistic infection prophylaxis after IRIS in children.

Other major changes to the guidelines include new immunization information and regulations, most specifically for pneumococcal, human papillomavirus, meningococcal, and rotovirus vaccines. There are specific sections on influenza, giardiasis, and isosporiasis. Eliminated from the previous edition are sections on certain infections, such as aspergillosis, bartonellosis, and HHV-6 and HHV-7.

Upon approval of the panel, the 2013 guidelines were endorsed by the NIH, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Disease Society and the American Academy of Pediatrics.

Source:

Stony Brook Children's Hospital

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