Published April, 2009
Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults, 58 MMWR 1, (2009)
These guidelines provide recommendations for preventing and treating opportunistic infections (OIs) among adults and adolescents living with HIV. They are intended for use by health care workers, patients, and policy makers. The guidelines are periodically updated, and this reflects an update of recommendations last published in 2004. Major changes include (1) greater emphasis on the importance of antiretroviral therapy for the prevention and treat¬ment of OIs, especially those OIs for which no specific therapy exists; (2) information regarding the diagnosis and management of immune reconstitution inflammatory syndromes; (3) information regarding the use of interferon-gamma release assays for the diagnosis of latent Mycobacterium tuberculosis (TB) infection; (4) updated information concerning drug interactions that affect the use of rifamycin drugs for prevention and treatment of TB; (5) the addition of a section on hepatitis B virus infection; and (6) the addition of malaria to the list of OIs that might be acquired during international travel.
The guidelines outline various OIs and, for each, discuss epidemiology, clinical manifestations, diagnosis, prevention of exposure; prevention of disease by chemoprophylaxis and vac¬cination; discontinuation of primary prophylaxis after immune reconstitution; treatment of disease; monitoring for adverse effects during treatment; management of treatment failure; prevention of disease recurrence; discontinuation of secondary prophylaxis after immune reconstitution; and special considerations during pregnancy. The recommendations also discuss the effectiveness of highly antiretroviral therapy (ART) in preventing and treating OIs, as well as the complications and obstacles in adhering to a HAART regimen.
The guidelines, issued by the CDC/Department of Health and Human Services, are the joint recommendations of CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.
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