From Reuters Health
Information CME
News Author: Megan
Brooks
CME Author: Laurie Barclay, MD
CME Author: Laurie Barclay, MD
CLINICAL
CONTEXT
A panel of specialists
in pediatric HIV infection and infectious diseases from the National Institutes
of Health, the Centers for Disease Control and Prevention, the HIV Medicine
Association of the Infectious Diseases Society of America, the Pediatric
Infectious Diseases Society, and the American Academy of Pediatrics issued
clinical guidelines for the prevention and treatment of opportunistic
infections (OIs) in HIV-exposed and HIV-infected US children.
For bacterial and
specific fungal and viral infections, pediatric specialists expert in each
condition reviewed the literature for new publications since the previous
guidelines in 2009. The full panel and endorsing organizations reviewed
proposed revisions. These guidelines target clinicians and other healthcare
workers providing medical care for HIV-exposed and HIV-infected children in the
United States, whereas a separate document offers guidelines for prevention and
treatment of OIs in HIV-infected adults and postpubertal adolescents.
STUDY
SYNOPSIS AND PERSPECTIVE
A US expert panel has
issued updated guidelines for preventing and treating opportunistic infections
(OIs) in HIV-exposed and infected children.
Jointly created by the
National Institutes of Health, the Centers for Disease Control and Prevention,
the HIV Medicine Association of the Infectious Diseases Society of America, the
Pediatric Infectious Diseases Society, and the American Academy of Pediatrics,
the new guidelines update previous recommendations issued in 2009.The document
includes updated immunization recommendations for HIV-exposed and HIV-infected
children, including pneumococcal, human papillomavirus (HPV), meningococcal,
and rotavirus vaccines."Ideally, HPV vaccine should be administered before
an individual becomes sexually active," the guidelines state.
"HIV-infected individuals should use latex condoms during every act of
sexual intercourse to reduce the risk of exposure to sexually transmitted
pathogens, including HPV."
And for influenza,
"The approach to evaluation and treatment of HIV-infected children on
stable combination antiretroviral therapy with suspected or confirmed influenza
should be similar to that of HIV-uninfected children," the guidelines say.
"Prevention of influenza in HIV-infected children aged 6 months and older
should include annual administration of trivalent inactivated influenza
vaccine, according to Advisory Committee on Immunization Practices
recommendations."
They further advise,
"Influenza-specific antiviral chemoprophylaxis should be considered for
HIV-infected children based on level of immunosuppression and other preexisting
co-morbidities, influenza vaccination status, and degree of exposure to
suspected or confirmed influenza, according to CDC guidelines. HIV-infected
children with confirmed influenza should be considered for prompt antiviral
therapy, according to CDC guidelines."
Panel member Dr. George
Siberry, who is with the Eunice Kennedy Shriver National Institute of Child
Health and Human Development in Bethesda, Maryland, told Reuters Health by
email that the new recommendations complement other US federal guidelines
covering OIs in adults with HIV, as well as antiretroviral treatment of
children, pregnant women, and adolescents and adults, "all of which are
available at www.aidsinfo.nih.gov."He said "selected key
updates" to the guidelines include a greater emphasis on the importance of
ART for prevention and treatment of OIs, especially those OIs for which no
specific therapy exists, and guidance about managing ART in children with OIs,
including potential drug-drug interactions.
The guidelines panel
notes in a 16-page executive summary, published online November 27 in the Journal
of the Pediatric Infectious Diseases Society, that "licensure of drugs
for children and their application in clinical care often relies on efficacy
data from adult trials in combination with pharmacokinetic, safety, and/or
observational data in children." Therefore, recommendations sometimes rely
on trials in adults with only supporting data in children.
The update also includes
"increased information about the diagnosis and management of immune
reconstitution inflammatory syndrome (IRIS)," Dr. Siberry said, and
"updated recommendations on discontinuation of OI prophylaxis after immune
reconstitution in children."
Posted by: Gauri Shah
Faculty Biotechnology
Bioinformatics Institute of India
Posts
