New US guidelines for treating OIs in CLHIV

[Guest guest]

Centers for Disease Control and Prevention, 

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 

News Media Line: 404-639-8895, <e-mail: NCHHSTPMediaTeam@...>

U.S. UPDATES CLINICAL GUIDELINES FOR PREVENTION AND TREATMENT OF OPPORTUNISTIC

INFECTIONS AMONG HIV-EXPOSED AND HIV-INFECTED CHILDREN 

New guidelines to assist health care workers in preventing and treating the

secondary infections that can afflict U.S. children exposed to, or infected

with, HIV, were published by the National Institutes of Health and the Centers

for Disease Control and Prevention. 

The new guidelines provide a reference manual for the treatment of these

secondary infections, describing warning signs of potentially hazardous

interactions between drugs used to treat HIV and its secondary infections,

current standards for treating the inflammation accompanying the immune system

recovery made possible by new anti-HIV drugs, as well as when to discontinue

preventative treatment no longer needed after the immune system has recovered.

HIV cripples the immune system, leaving infected people more vulnerable than the

general population to numerous other infectious diseases.  These diseases, which

ordinarily do not cause problems for people with fully functioning immune

systems, are known as opportunistic infections.  HIV-associated opportunistic

infections are a leading cause of hospitalization and death among HIV-infected

children in the United States.  Some of these opportunistic infections can also

afflict children who do not have HIV but who have one or both parents with HIV

and specific HIV-related opportunistic infections.

" The guidelines will help health care workers and public health officials who

work with children to save lives that might otherwise be lost, " said Kathleen

Sebelius, secretary of the U.S. Department of Health and Human Services.  " The

infections that can accompany HIV are often the major cause of illness and death

of HIV-infected children. "

The report, Guidelines for Prevention and Treatment of Opportunistic Infections

in HIV-Exposed and HIV-Infected Children, updates recommendations on topics such

as the importance of starting antiretroviral treatment early and interactions

between drugs that treat HIV and drugs that treat opportunistic infections.

The report, the first update of the guidelines in five years, appears in the

Sept. 4 issue of Morbidity and Mortality Weekly Report (MMWR).  The NIH and CDC

produced the update in cooperation with the HIV Medicine Association of the

Infectious Diseases Society of America, the American Academy of Pediatrics, and

the Pediatric Infectious Disease Society.

The new guidelines apply to 23 opportunistic infectious diseases.  A panel of

more than 30 government and non-government pediatric HIV and infectious disease

experts developed the guidelines.  The guidelines update and combine two

previous publications, a 2002 publication on the prevention of opportunistic

infections in HIV-infected adults and children and a 2004 publication on the

treatment of opportunistic infections in children.

In recent years, the number of HIV-associated opportunistic infections in

children has declined significantly in the United States.  The decrease is

primarily due to advances in antiretroviral therapy.  But the infections

continue to occur, and they can be serious or even fatal.

" Health care providers must be vigilant for the signs and symptoms of these

infections and know how to prevent and treat them, " said Lynne Mofenson, M..D.,

a coauthor of the new guidelines and chief of NICHD's Pediatric, Adolescent, and

Maternal AIDS Branch.

Because children's immune systems are not as developed as adults, even children

who do not have HIV may be at high risk of catching certain opportunistic

infections, such as tuberculosis, if one or both parents have HIV and an

accompanying opportunistic infection.  Like HIV itself, some opportunistic

infections, such as cytomegalovirus or hepatitis viruses, can be passed from

mother to child.

" Guidelines for preventing and treating opportunistic infections in children

must consider the risk of infections among both HIV-infected children and

children who were HIV-exposed through birth to an HIV-infected mother. " Dr..

Mofenson said.

In recent years, HIV infection has increased among adolescents.

" We hope that doctors and clinicians make use of these new guidelines to ensure

that adolescents with HIV are not severely impacted by other infections, " said

L. Dominguez, M.D., a coauthor of the new guidelines and epidemiologist

at CDC's Divsion of HIV/AIDS Prevention.  " Despite our country's strong success

in preventing perinatally HIV-infected infants, we must protect the significant

numbers of current HIV-infected children and adolescents who are able to live

longer, healthier lives due to advances in HIV therapy. "

Drug doses and response to treatment may differ for children or adolescents

entering puberty than for adults. Guidelines for adults and postpubertal

adolescents appear in another report, Guidelines for Prevention and Treatment of

Opportunistic Infections in HIV-Infected Adults and Adolescents, published in

the April 10, 2009, issue of MMWR.

Major changes in the pediatric guidelines include:

-- Emphasis on the importance of effective antiretroviral therapy to improve

children's immune function.  The development of new therapies for HIV in

children in recent years has shown that successful treatment of HIV itself is

pivotal to preventing and controlling opportunistic infections.

-- Information on diagnosing and managing immune reconstitution inflammatory

syndrome.  In this condition, the immune system begins to recover but then

responds to a previously acquired opportunistic infection with an overwhelming

response that worsens the symptoms of infection.  Despite the worsening

symptoms, continuing antiretroviral treatment is critical, the guidelines say. 

-- Information on the management of antiretroviral therapy in children with

opportunistic infections, including potential drug-drug interactions. 

-- New guidance on use of antibiotic drugs to prevent Pneumocystis jirovecii

pneumonia in infants. Previously, doctors were advised to give an antibiotic to

all infants born to HIV-infected mothers to prevent infection with Pneumocystis

jirovecii pneumonia, starting at 4-6 weeks until the infant tested negative for

HIV at 4-6 months of age or was found to be HIV-infected.  With advances in

diagnostic testing and effective prevention of mother to child transmission, the

new guidelines note that if infants have two negative tests for HIV at early

timepoints (one at 2 weeks or older and one at 4 weeks or older), use of

antibiotics to prevent this infection may be avoided. 

-- Updated immunization recommendations for HIV-exposed and -infected children,

including hepatitis A, human papillomavirus, meningococcal, and rotavirus

vaccines.

-- A new section outlining treatments for malaria, which may become an

opportunistic infection in HIV-infected immigrant children or HIV-infected

children who travel to countries with malaria. 

-- New recommendations on when to discontinue medication for preventing

opportunistic infections.  Previously, medications to prevent opportunistic

infections were given for life.  Now, however, new therapies that inhibit HIV

may allow the immune system to recover.  When the immune system has recovered

sufficiently, the medications to prevent opportunistic infections may no longer

be needed.  The guidelines list diagnostic criteria for discontinuing these

medications.  

The new guidelines (as well as all federal HIV prevention and treatment

guidelines) appear on the AIDSinfo Web site, <http://www.aidsinfo.nih.gov/>. 

Because treatment of opportunistic infections in children continues to evolve,

NIH and CDC will update the recommendations as new treatments or clinical data

on existing treatments become available.

The Centers for Disease Control and Prevention (CDC), part of the U.S.

Department of Health and Human Services, protects people's health and safety by

preventing and controlling diseases and injuries; enhances health decisions by

providing credible information on critical health issues; and promotes healthy

living through strong partnerships with local, national, and international

organizations. For more information about CDC and its programs, visit

<http://www.cdc.gov>.

The NICHD sponsors research on development, before and after birth; maternal,

child, and family health; reproductive biology and population issues; and

medical rehabilitation. For more information, visit the Institute's Web site at

<http://www.nichd.nih.gov/>.

The National Institutes of Health (NIH) -- The Nation's Medical Research Agency

-- includes 27 Institutes and Centers and is a component of the U.S. Department

of Health and Human Services. It is the primary federal agency for conducting

and supporting basic, clinical and translational medical research, and it

investigates the causes, treatments, and cures for both common and rare

diseases. For more information about NIH and its programs, visit www.nih.gov.

Dr. Rajesh  Gopal,MD

Joint  Director,

Gujarat  State  AIDS  Control  Society (GSACS),

O/1 Block, New  Mental Hospital  Complex,

Meghaninagar,Ahmedabad, Gujarat.

PIN 380016 Phone (O) 079-22680211--12--13,22685210 Fax 079-22680214

E-MAIL: <dr_rajeshg@...>