Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children Recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society (This guideline was simultaneously published in The Pediatric Infectious Disease Journal on November 6, 2013.) Prepared by George K. Siberry MD, MPH, Executive Edward Handelsman MD;1,§ Secretary;1 Lynne M. Mofenson MD;1 Mark J. Abzug MD, Co-Chair;2 Steve Nesheim MD;5 Sharon Nachman MD, Co-Chair;3 and the Panel on Opportunistic Infections in HIV- Michael T. Brady MD;4 Exposed and HIV-Infected Children* Kenneth L. Dominguez MD, MPH;5 1National Institutes of Health, Bethesda, Maryland 2University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado 3State University of New York at Stony Brook, Stony Brook, New York 4Nationwide Children’s Hospital, Columbus, Ohio 5Centers for Disease Control and Prevention, Atlanta, Georgia * Panel member authors (in alphabetical order): Debika Bhattacharya, MD; Beverly Bohannon, MS, RN; Diana Clarke, Pharm. D.; Kathryn M. Edwards, MD; Jennifer C. Esbenshade, MD, MPH; Patricia Flynn, MD; Aditya Gaur, MD; Francis Gigliotti, MD; Gail Harrison, MD; Charlotte Victoria Hobbs, MD; David Kimberlin, MD; Martin B. Kleiman, MD; Emilia H. Koumans, MD, MPH; Andrew Kroger, MD, MPH; Myron J. Levin. MD; Cara L. Mack, MD; Ben J. Marais, MD; Gabriela Maron, MD; James McAuley, MD, MPH; Heather J. Menzies, MD, MPH; Anna-Barbara Moscicki, MD; Michael R. Narkewicz, MD; Richard Rutstein, MD; Jane Seward, MBBS, MPH; Masako Shimamura, MD; William J. Steinbach, MD; Gregory J. Wilson, MD. § Dr. Handelsman, Branch Chief of the Maternal, Adolescent, and Pediatric Research Branch of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, died unexpectedly on March 5, 2012.Dr. Handelsman was a pediatrician dedicated to the care of HIV-infected infants, children, adolescents, and pregnant women whose work and advocacy saved the lives and improved the health of thousands of children around the world. How to Cite the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children: Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/ oi_guidelines_pediatrics.pdf. Section accessed [insert date] [insert page number, table number, etc., if applicable] It is emphasized that concepts relevant to HIV management evolve rapidly. The Panel has a mechanism to update recommendations on a regular basis, and the most recent information is available on the AIDSinfo website Access AIDSinfo (http://aidsinfo.nih.gov). mobile site What’s New After the 2013 full guidelines release, the Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children (the Panel) modified its process so that individual sections would be published as they were updated, allowing for more timely appearance of new recommendations. Each section will be marked with the date of its last update and the summary of changes will be listed below. For a full description of the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children, see the updated Summary. Additionally, the evidence review and recommendation rating system underwent major changes; this new approach is incorporated into sections as they are individually updated. As a result, topics not yet updated since the 2013 release reflect the former rating system, and sections updated since 2013 use a newer, modified GRADE system. A description of the methods of collecting and synthesizing evidence and formulating and rating recommendations appears in the Background and Recommendations Rating Scheme section. Major section revisions within the last 6 months are as follows: December 9, 2019 1. Varicella-Zoster Virus: The Panel updated this section to include new information on VariZIG, which is now readily available for passive immunization when indicated. Additional evidence now supports protection by VariZIG when administered within 10 days of exposure to varicella-zoster virus (VZV). The section has also been updated to reflect the new recommendation rating system and references were added. October 25, 2019 1. Vaccine-Preventable Diseases in Children and Adolescents with HIV Infection: The Panel updated this section and the recommended immunization schedule to include new vaccines available for the prevention of meningococcal infection (MenACWY-D [Menactra], MenACWY-CRM [Menveo], MenB-4C [Bexsero], and MenB-FHbp [Trumenba]) and HPV (9vHPV), and to include an expanded discussion of yellow fever vaccine (YFV) recommendations for children with HIV. The section has also been updated to reflect the new recommendation rating system and references were added. The recommended immunizations schedule has been consolidated from two figures (ages 0-6 and 7-18 years) into a single schedule (Figure 1) spanning birth through age 18 years. Updates reflect 2019Advisory Committee on Immunization Practices (ACIP) recommendations, which include specific recommendations for children with HIV. August 29, 2019 1. Cryptosporidiosis: There are no major changes to the guidance for the diagnosis and management of cryptosporidiosis in children and adolescents living with HIV. Minor updates to the main text of the section include additional information on epidemiology, clinical manifestations and new diagnostic methodologies, along with updated references and links to additional resources on preventive measures. The section has been updated to reflect the new recommendation rating system. August 22, 2019 1 Giardiasis: There are no major changes to the guidance for the diagnosis and management of giardiasis in children and adolescents living with HIV. Minor updates to the main text of the section include information on new diagnostic methodologies and additional details on the approach to diagnosis when giardiasis is suspected but stool testing is negative. The section has been updated to reflect the new recommendation rating system and references were added. Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children i Table of Contents Summary .......................................................................................................................................................A-1 Background and Recommendations Rating Scheme ................................................................................ B-1 Preventing Vaccine-Preventable Diseases in Children and Adolescents with HIV Infection ............... C-1 Bacterial Infections ......................................................................................................................................D-1 Candida Infections ........................................................................................................................................ E-1 Coccidioidomycosis .......................................................................................................................................F-1 Cryptococcosis ..............................................................................................................................................G-1 Cryptosporidiosis .........................................................................................................................................H-1 Cytomegalovirus ........................................................................................................................................... I-1 Giardiasis ....................................................................................................................................................... J-1 Hepatitis B Virus ..........................................................................................................................................K-1 Hepatitis C Virus.......................................................................................................................................... L-1 Herpes Simplex Virus Infections ............................................................................................................... M-1 Histoplasmosis ..............................................................................................................................................N-1 Human Herpesvirus 8 Disease ....................................................................................................................O-1 Human Papillomavirus .................................................................................................................................P-1 Influenza........................................................................................................................................................Q-1 Isosporiasis (Cystoisosporiasis)................................................................................................................... R-1 Malaria ...........................................................................................................................................................S-1 Microsporidiosis ..........................................................................................................................................