Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the United States Department of Health and Human Services.

Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV

United States Department of Health and Human Services

Publication Date: May 27, 2026

Page Last Updated: May 28, 2026

Vaccination Recommendations

For all people with HIV without history of pneumococcal vaccination or unknown vaccine history:
- Administer either 15-valent pneumococcal conjugate vaccine (PCV15) or 20-valent pneumococcal conjugate vaccine (PCV20) (AII). If PCV20 is used, their pneumococcal vaccination is complete.
- If PCV15 is used, a dose of PPSV23 should be administered at least 8 weeks later (AII).* No additional pneumococcal vaccine doses are recommended.
For people with HIV who previously started or completed a pneumococcal vaccination series, there is no need to restart the series.**
- People with HIV who received PCV13 and were 65 or older when they received a dose of PPSV23 do not require further doses of PPSV23; for those who received PPSV23 younger than age 65, additional doses of PPSV23 are recommended as indicated below (BIII).
  - People with HIV who have received PCV13 and PPSV23 at age <65 should receive a second dose of PPSV23 at least 5 years after the first dose. If they are age 65 or older at the time of their second dose, they do not require additional doses of PPSV23.
  - If they were <65 at the time of the second dose, they should receive a third and final dose at or after age 65, at least 5 years after the second PPSV23 dose.
- People with HIV who have only received PPSV23 may receive a PCV (either PCV20 or PCV15) ≥1 year after their last PPSV23 dose. When PCV15 is used in those with history of PPSV23 receipt, it need not be followed by another dose of PPSV23 at any age (BIII).

* Patients with CD4 counts >200 cells/mm3 should receive a dose of PPSV23 at least 8 weeks later (AI). While individuals with HIV with CD4 counts <200 cells/mm3 can also be offered PPSV23 at least 8 weeks after receiving PCV15 (CIII) (such as if there are concerns with retention in care), PPSV23 should preferably be deferred until after an individual’s CD4 count increases to >200 cells/mm3 while on ART (BIII). Clinical evidence supporting use of PPSV23 in persons with CD4 counts <200 cells/mm3 appears strongest in patients who also have HIV RNA <100,000 copies/mL; evidence also suggests benefit for those who start ART before receiving PPSV vaccination.

** People with HIV who have received PCV13 but have not completed their recommended pneumococcal vaccine series with PPSV23, one dose of PCV20 may be used if PPSV23 is not available. If PCV20 is used, their pneumococcal vaccinations are complete (CIII).

Induction Therapy (Duration: 2 Weeks, Followed by Consolidation Therapy)

Irrespective of which regimen is used, patients must be followed carefully in the hospital for at least 7 days and ideally 14 days (AII). LP should be performed at Day 7 and Day 14 to ensure an appropriate clinical response and culture sterility. If increased ICP is documented, daily LP should be performed until the pressure is decreased into the normal range and symptoms have abated (AII).

Preferred Regimens

In the United States and other settings where daily monitoring of electrolytes and kidney function and administration of electrolytes and IV fluid is possible:
- Liposomal amphotericin B 3–4 mg/kg IV once daily plus flucytosine 25 mg/kg PO four times a day for 2 weeks (AII)
In resource-limited health care systems, as recommended by the World Health Organization:
- Liposomal amphotericin B 10 mg/kg IV as a single dose on Day 1, followed by flucytosine 25 mg/kg PO four times a day plus fluconazole 1,200 mg PO daily for 2 weeks (AI)

Alternative Regimens

Amphotericin B lipid complex 5 mg/kg IV daily plus flucytosine 25 mg/kg PO four times a day for 2 weeks (BII), or
Amphotericin B deoxycholate 1 mg/kg IV daily plus flucytosine 25 mg/kg PO four times a day for 1 week, followed by fluconazole 1,200 mg PO daily for an additional week (BI)
Note: The flucytosine dose should be adjusted in renal impairment and ideally use TDM (see Table 6).

Additional Studied Regimens (Duration of Therapy: 2 Weeks)

Amphotericin B deoxycholate 0.7–1.0 mg/kg IV once daily plus flucytosine 25 mg/kg PO four times a day (BI)
Liposomal amphotericin B 3–4 mg/kg IV once daily plus fluconazole 800–1,200 mg PO once daily (BIII)
Amphotericin B deoxycholate 0.7–1.0 mg/kg IV once daily plus fluconazole 800–1,200 mg PO once daily (BI)
Fluconazole 1,200 mg PO or IV once daily plus flucytosine 25 mg/kg PO four times a day (BII)
If the patient has not improved clinically or remains clinically unstable, continue or start (liposomal amphotericin B or amphotericin B deoxycholate) plus flucytosine induction therapy until the CSF culture is confirmed to be negative (BIII).

Additional Considerations

CSF opening pressure should always be measured when an LP is performed. Repeated therapeutic LPs are essential to manage symptomatic increased ICP and have a survival benefit (AII).
Corticosteroids should not be used routinely during induction therapy unless used for management of IRIS (AI).
Corticosteroids, acetazolamide, and mannitol are ineffective in reducing ICP and are not recommended (AIII).

Special Considerations When Initiating Tenofovir-Sparing ARV Regimens

In people without a history of chronic HBV infection:
- Within 3 months prior to initiating or switching to a tenofovir-sparing ARV regimen, HBsAg, anti-HBs, and anti-HBc should be checked to evaluate for unrecognized chronic HBV infection and absence of immunity (AIII), including in individuals with prior receipt of the HepB vaccine (AIII).
In people with chronic HBV infection (HBsAg positive):
Anti-HBV therapy (TDF, TAF, or entecavir) must be given if switching to a tenofovir-sparing ARV regimen (e.g. DTG/RPV or long-acting CAB/RPV) (AII).
Switching to the one-pill regimen of DTG/3TC without additional anti-HBV therapy (TDF, TAF, or entecavir) should be avoided (AII). Chronic administration of 3TC alone is not recommended because of the high rate of selection of HBV drug-resistance mutations (AI).
HBsAg should be checked yearly after ART initiation (AIII). If HBsAg loss occurs and is maintained for at least 6 months and there is a desire to switch to a tenofovir-sparing regimen, this option may be considered.
In people with anti-HBc and anti-HBs positivity:
- Switching to a tenofovir-sparing ARV regimen without additional anti-HBV therapy is appropriate since there is a low risk of HBV reactivation (AIII). ALT monitoring every 3 months for the first 6 months, then every 6 months thereafter post-switch is recommended (BIII). An ALT increase would warrant HBV DNA testing.
In people with isolated anti-HBc positivity (HBsAg negative and anti-HBc positive and anti-HBs negative):
- Switching to DTG/3TC or a tenofovir-sparing ARV regimen without additional anti-HBV therapy can be considered, but there is a low risk of HBV reactivation. Therefore, ALT monitoring every 3 months for the first 6 months and then every 6 months thereafter post-switch is recommended (BIII). An ALT increase would warrant HBV DNA testing.
- HepB vaccination initiated at the time of switch is recommended (see Vaccination Schedule for People With Isolated Anti‌‑HBc) (AII).
- Some experts recommend that HBV DNA be undetectable prior to switching to DTG/3TC or tenofovir-sparing ARV regimen (CIII).
In people nonreactive for anti-HBc and anti-HBs:
- Completing a HepB vaccination series and checking anti-HBs prior to switching to a tenofovir-sparing ARV regimen is recommended (AI).
Note: If a tenofovir-sparing regimen is initiated, ongoing review of risk factors for reactivation is recommended, e.g., introduction of immunosuppressive therapies (see Considerations When Using Tenofovir-Sparing Regimens).

Other Considerations

Because people with HBV/HCV/HIV coinfection appear to have accelerated liver fibrosis progression, higher risk of HCC, and increased mortality, treatment for both HBV and HCV infection should be initiated (AII).
Because HBV reactivation can occur during treatment for HCV with direct-acting antivirals in the absence of anti-HBV therapy, all people with HIV/HBV coinfection who will be treated for HCV infection should be on HBV-active ART at the time of HCV treatment initiation (AIII).
When changing ART regimens in people with HIV/HBV coinfection, it is crucial to continue agents with appropriate anti-HBV activity (TDF or TAF) or to initiate entecavir due to risk of HBV reactivation with hepatic flare after stopping anti-HBV treatment (AIII).
If anti-HBV therapy must be discontinued (i.e., due to medication intolerance, contraindications, or patient preference), serum transaminase and HBV DNA levels should be monitored every 6 weeks for 3 months and then every 3 to 6 months thereafter (AIII).
If a hepatic flare occurs after drug discontinuation, HBV therapy should be reinstituted because it can be potentially lifesaving (AIII).
If immunosuppressive therapy is given, HBV reactivation can occur. Thus:
- People who are HBsAg positive should be administered treatment for HBV infection regardless of HBV DNA level (AII).
- For people who are HBsAg negative/anti-HBc positive and will receive low-risk immunosuppression (as defined by the AGA), monitoring HBV DNA and ALT at 1 to 3 month intervals is recommended if they are not on a TDF/TAF-based ART regimen (BIII).
- For people who are HBsAg negative/anti-HBc positive and will receive moderate- or high-risk immunosuppression (as defined by the AGA), TDF or TAF plus FTC or 3TC is recommended as part of the ART regimen prior to immunosuppression to prevent reactivation (BII).
- For people who are HBsAg negative/anti-HBc positive who cannot be given TDF or TAF and will receive moderate- to high-risk immunosuppression, prophylaxis with entecavir can be administered to prevent reactivation (BII) (see the Special Considerations During Immunosuppressive Therapy section below).
- Treatment to prevent reactivation should be continued for 6 months after immunosuppressive therapy is complete or for 12 months after anti-CD20 therapy is complete (BIII).
For information regarding drug–drug interactions, such as with tenofovir products and certain antimycobacterial, anti-HCV, or anti-seizure therapies, see the Liverpool HEP Drug Interaction Checker.

Acyclovir-Resistant Mucocutaneous HSV Infections

Treatment failure due to acyclovir resistance should be suspected if lesions do not begin to resolve within 7–10 days after initiation of anti-HSV therapy. All acyclovir-resistant strains are also resistant to valacyclovir, and most are resistant to famciclovir.
Treatment of acyclovir-resistant HSV should be given in consultation with an infectious disease expert (AIII).

Preferred Therapy

IV foscarnet 40 mg/kg every 8–12 hours until clinical response (AI)

Alternative Therapy

Topical imiquimod 5% cream three times a week (BIII), or
Topical cidofovir 1% gel once daily (BIII), or
Topical trifluridine 1% three times a day (BIII), or
Topical foscarnet 1% five times a day (BIII), or
IV cidofovir 5 mg/kg once weekly for 2 weeks, then every other week (CIII)
- Administer probenecid 2 g PO 3 hours before each cidofovir dose followed by 1 g PO 2 hours after the dose, and 1 g PO 8 hours after the dose (total of 4 g). Administer 1 L of normal saline before and, if additional fluid load can be tolerated, administer another 1 L of normal saline after each cidofovir infusion.
- Note: Cidofovir should be avoided in patients with sulfonamide allergy because of cross-hypersensitivity with probenecid.

Duration

Based on clinical response; typically 21–28 days or longer

Notes

An expanded access program of oral pritelivir is available for immunocompromised people with acyclovir-resistant HSV infection; see the Managing Treatment Failure in Mucocutaneous Disease section for more information.
Topical formulations of trifluridine, cidofovir, and foscarnet are not commercially available. Extemporaneous compounding of topical products can be prepared using trifluridine ophthalmic solution and the IV formulation of cidofovir and foscarnet.
Recurrences following episodes of acyclovir-resistant HSV can be caused by either acyclovir-resistant or acyclovir-sensitive strains; after resolution of the acyclovir-resistant episode, suppressive therapy with acyclovir can be considered to prevent additional recurrences (CIII).

Other Considerations

Random itraconazole serum concentrations should be measured in all patients after 2 weeks of therapy (the time it usually takes to reach a steady state) to ensure adequate absorption and to assess changes in hepatic metabolism due to drug interactions (AIII).
Random serum concentrations (itraconazole plus hydroxyitraconazole) should be between 1 and 2 µg/mL. Concentrations ≥5 µg/mL are associated with an increased frequency and severity of adverse effects.
Oral itraconazole liquid solution is preferred over the capsule formulation because of improved absorption but is less well tolerated. However, it is not necessary to use the liquid solution if random serum itraconazole concentration is ≥1.0 µg/mL with the capsule formulation (AIII).
Trough voriconazole serum concentrations should be measured after 5 days of therapy (the time it usually takes to reach a steady state) with the goal of achieving a concentration of 1 to 5 µg/mL. Concentrations are highly variable among patients, and for individual patients, concentrations can vary because of drug–drug interactions. Neurotoxicity and hepatotoxicity are associated with serum concentrations >5 µg/mL, but some patients can experience adverse effects with lower serum concentrations (AIII).
Trough posaconazole serum concentrations should be measured after 5 days of therapy (the time it usually takes to reach a steady state) to ensure adequate absorption, with a goal of achieving a concentration >1 µg/mL (AIII).
Acute pulmonary histoplasmosis in patients with HIV and CD4 count ≥300 cells/mm3 should be managed the same as in immunocompetent patients (AIII).
All triazole antifungals have the potential to interact with certain ART agents and other anti-infective agents. These interactions are complex and can be bidirectional. The Drug–Drug Interactions section in the Adult and Adolescent Antiretroviral Guidelines lists these interactions and recommends dose adjustments where feasible. The University of Liverpool HIV Drug Interactions Database provides more detailed information on interactions.

Preventing First Episode of Disseminated MAC Disease (Primary Prophylaxis)

Primary prophylaxis is not recommended for people with HIV who immediately initiate ART, regardless of CD4 count (AII).

Indications for Primary Prophylaxis

CD4 count <50 cells/mm3 and not receiving ART, remain viremic on ART, or have no options for a fully suppressive ART regimen (AI)
Before primary prophylaxis is initiated, disseminated MAC disease should be ruled out by clinical assessment and, if appropriate, by obtaining a blood culture for MAC (AI). If blood culture is obtained, prophylaxis should be delayed until results are available to avoid exposing patients to monotherapy and the attendant risk of drug resistance (AI).

Preferred Therapy

Azithromycin 1,200 mg PO once weekly (AI), or
Clarithromycin 500 mg PO twice daily (AI), or
Azithromycin 600 mg PO twice weekly (BIII)

Alternative Therapy

Rifabutin 300 mg PO daily (BI) for people who cannot tolerate azithromycin or clarithromycin
Dose adjustment of rifabutin or concomitant ARVs may be necessary based on drug–drug interactions.
Active TB should be ruled out before starting rifabutin to avoid monotherapy which could result in acquired rifamycin resistance.
For information on drug–drug interactions between antimycobacterial agents (e.g. clarithromycin and rifabutin) and concomitant ARVs, refer to the Liverpool HIV Drug Interaction Checker.

Indication for Discontinuing Primary Prophylaxis

If previously initiated, primary prophylaxis should be discontinued for those continuing on a fully suppressive ART regimen (AI).

Pregnancy Considerations

During pregnancy, if ART is immediately initiated, then primary prophylaxis for MAC disease is not recommended (AIII).
When primary prophylaxis is required because of the absence of effective ART, azithromycin is the preferred agent during pregnancy (BIII).
Clarithromycin is not recommended as a first-line agent for prophylaxis of MAC during pregnancy (BIII).

Treating LTBI to Prevent TB Disease in People with HIV

Indications

Positive screening testa for LTBI (≥5 mm of induration at 48–72 hours in people with HIV or positive IGRA) regardless of BCG status, no evidence of active TB disease, and no prior history of treatment for active disease or latent TB infection (AI).
Close contact with a person with infectious TB (such as someone who has shared air space, such as in a household or close congregate setting, with a person with active pulmonary TB according to the Centers for Disease Control and Prevention Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis) regardless of screening test result and CD4 count (AII).

Preferred Therapy

Isoniazid 15 mg/kg PO once weekly (900 mg maximum) plus rifapentine (see weight-based dosing below) PO once weekly plus pyridoxine 50 mg PO once weekly (3HP) for 12 weeks (AI). Note: 3HP is recommended only for virally-suppressed patients receiving an efavirenz-, raltegravir-, or once-daily dolutegravir-based ARV regimen (AII).
Rifapentine Weekly Dose (maximum 900 mg)
- Weighing 25.1–32 kg: 600 mg
- Weighing 32.1–49.9 kg: 750 mg
- Weighing ≥50.0 kg: 900 mg
Isoniazid 300 mg PO daily plus rifampin 600 mg PO daily plus pyridoxine 25–50 mg PO daily (AI) for 3 months (3HR). See the Dosing Recommendations for use of ARV and Anti-TB Drugs When Treating Latent TB table for the list of ARV drugs not recommended for use with rifampin (e.g., protease inhibitors, bictegravir) and those which require dosage adjustment (i.e., raltegravir, dolutegravir, or maraviroc).

Alternative Therapy

Isoniazid 300 mg PO daily plus pyridoxine 25–50 mg PO daily for 6–9 months (AII) or
Rifampin 600 mg PO daily for 4 months (BI) (4R)
- Consult the Tuberculosis/HIV Coinfection section of the Adult and Adolescent Antiretroviral Guidelines for the list of ARV drugs not recommended for use with rifampin (e.g., protease inhibitors, bictegravir) and those which require dosage adjustment (e.g., raltegravir, dolutegravir, or maraviroc).
Isoniazid 300 mg PO daily plus rifapentine (see weight-based dosing below) PO daily plus pyridoxine 25–50 mg PO daily for 4 weeks (BI) (1HP) Note: 1HP is recommended only for patients receiving an efavirenz-based ARV regimen (AI).
Rifapentine Daily Dose (maximum 600 mg)
- Weighing <35 kg: 300 mg
- Weighing 35–45 kg: 450 mg
- Weighing >45 kg: 600 mg
For people exposed to drug-resistant TB, select drugs for prevention of TB after consultation with experts and with public health authorities (AIII).

Pregnancy Considerations

During pregnancy, 4R and 3HR are acceptable alternative regimens (BIII).
For pregnant women receiving effective ART and without close household contact with infectious TB or recent test for TB infection (TST or IGRA) conversion from negative to positive, therapy for LTBI may be deferred until after delivery (BIII).
Although rifampin generally is considered safe in pregnancy, data on the use of rifapentine are extremely limited and its use in pregnancy is not currently recommended (BIII).

Additional Considerations

Deferring ART until after completion of treatment for LTBI is not recommended (AI).
Given the important drug–drug interactions between rifamycins and several antiretroviral (ARV) agents, selection of an LTBI regimen will depend on a patient’s current or planned ARV regimen.

Pregnancy Considerations

For Moderate-to-Severe PCP Preferred Therapy

TMP-SMX, regardless of disease (AIII)
Although a small increased risk of birth defects may be associated with first-trimester exposure to trimethoprim, women in their first trimester with PCP should be treated with TMP-SMX because of its considerable benefit in reducing morbidity and mortality, which outweighs potential risk (AIII).
For women who are on TMP-SMX, clinicians should consider giving supplemental folic acid 4 mg/day if they are capable of becoming pregnant, or as soon as possible in their first trimester (BIII). Doses of supplemental folic acid of 4 mg/day should be limited to the first trimester during the teratogenic window and can be reduced to 0.4 mg at 12 weeks continuing to 4–6 weeks postpartum or discontinuation of breastfeeding (AIII).
Whether or not supplemental folic acid is administered during the first trimester, a follow-up ultrasound is recommended at 18 weeks to 20 weeks to assess fetal anatomy with consideration for follow-up scans subsequently (BIII).

Alternative Therapy

IV pentamidine (BIII)
If other alternatives are not available or tolerated, primaquine plus clindamycin (BIII)
- Because of concerns about hemolytic anemia in exposed fetuses who are G6PD deficient (which cannot be diagnosed antenatally), primaquine (plus clindamycin) should be used in pregnancy only if other alternatives are not available or tolerated and benefit is felt to outweigh the risk (AIII).

For Mild-to-Moderate PCP Preferred Therapy

TMP-SMX, regardless of disease (AI)

Alternative Therapy

Atovaquone suspension (BIII)
If atovaquone is not available or tolerated, dapsone plus TMX (BIII)
- Because of concerns about hemolytic anemia in exposed fetuses who are G6PD deficient, primaquine or dapsone should be used in pregnancy only if other alternatives are not available or tolerated and benefit is felt to outweigh the risk (AIII).

Note: As with other adults with HIV, G6PD levels should be checked before administration of primaquine or dapsone during pregnancy. While the G6PD level in a fetus generally is unknown during pregnancy, G6PD deficiency is an X-linked inherited condition and primaquine or dapsone can be considered if both the pregnant woman and biologic father have normal G6PD activity.
Adjunctive Corticosteroid Therapy

During pregnancy, adjunctive corticosteroid therapy should be used to improve treatment outcomes as indicated in any other person with HIV (AIII). Maternal glucose levels and blood pressure should be monitored closely when corticosteroids are used in pregnancy, as well as fetal growth (AIII).
Patients on chronic steroid therapy during pregnancy for non-hypothalamic-pituitary-adrenal axis disorders do not need stress doses of steroids for vaginal or cesarean delivery but should be continued on their therapeutic dose of steroids without interruption (BIII).

Indications for Initiating Secondary Prophylaxis

Prior PCP

Preferred Therapy

TMP-SMX, 1 DS tablet PO dailya (AI), or
TMP-SMX, 1 SS tablet PO dailya (AI)
Note: TMP-SMX also confers protection against toxoplasmosis and some protection against many respiratory bacterial infections. Patients who are receiving pyrimethamine/sulfadiazine for treatment or suppression of toxoplasmosis do not require additional prophylaxis for PCP (AII).

Alternative Therapy

The following regimens can be used for people who are seropositive or seronegative for Toxoplasma gondii:
- TMP-SMX one DS tablet PO three times weekly (BI), or
- Dapsonea 50 mg PO daily with pyrimethamine 50 mg plus leucovorin 25 mg PO weekly (BI), or
- Dapsonea 200 mg plus pyrimethamine 75 mg plus leucovorin 25 mg PO weekly (BI), or
- Atovaquone 1,500 mg PO daily with food (BI)
The following regimens should only be used in people who are seronegative for Toxoplasma gondii:
- Dapsonea 100 mg PO daily (BI), or
- Aerosolized pentamidine 300 mg via Respirgard II nebulizer every month (BI), or
- Intravenous pentamidine 300 mg every 28 days (CIII)

Indications for Discontinuing Secondary Prophylaxis

CD4 count increased from <200 cells/mm3 to ≥200 cells/mm3 for ≥3 months as a result of ART (AII), or
Can consider if CD4 count is 100–200 cells/mm3 and HIV RNA remains below limits of detection of assay used for 3 to 6 months (BII)
For people with HIV in whom PCP occurs at a CD4 count >200 cells/mm3 while not on ART, discontinuation of prophylaxis can be considered once HIV RNA levels are suppressed to below limits of detection of the assay used for ≥3 to 6 months, although there are no data to support recommendations in this setting (CIII).
Note: If an episode of PCP occurs at a CD4 count >200 cells/mm3 while a patient is on ART, it would be prudent to continue PCP prophylaxis for life, especially with plasma HIV RNA below level of detection, regardless of how high the CD4 cell count rises as a consequence of ART (BIII).

Indications for Restarting Secondary Prophylaxis

CD4 count <100 cells/mm3 regardless of HIV RNA (AIII), or
CD4 count 100–200 cells/mm3 and HIV RNA above detection limit of the assay used (AIII)

View External Table

Recommendation Grading

Document Overview

Document Title: Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV

Authoring Society: United States Department of Health and Human Services

Document Publication Date: May 27, 2026

Page Last Reviewed/Updated: May 28, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/whats-new

Source Citation: Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. National Institutes of Health, HIV Medicine Association, and Infectious Diseases Society of America. Year. Available at https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: Provide guidance to HIV care practitioners and others on the optimal prevention and management of HIV-related opportunistic infections (OIs) for adults and adolescents in the United States.

Scope: Management, Prevention, Treatment

Diseases/Conditions (MeSH)

D015658 - HIV Infections

D006678 - HIV

Keywords: HIV, HIV comorbidities, HIV infections

Inclusion Criteria: Male, Female, Adolescent, Adult, Older Adult

Health Care Settings: Ambulatory, Hospital, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Rating of Recommendations
A	Strong
B	Moderate
C	Optional
Rating of Evidence
I	One or more randomized trials with clinical outcomes and/or validated laboratory endpoints
II	One or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes
III	Expert opinion

Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV

Summary of Recommendations

Bacterial Enteric Infections

Preventing Bacterial Enteric Infections

Treating Bacterial Enteric Infections

General Considerations When Managing Patients With Bacterial Enteric Infections

Empiric Treatment of Bacterial Enteric Infections (Pending Diagnostic Studies and Antimicrobial Resistance Testing)

For People With HIV and CD4 >500 cells/mm3, With 1–2 Days of Loose Stools Without Fever or Blood

For People With HIV and CD4 Count 200–500 cells/mm3, With Diarrhea Severe Enough to Compromise Quality of Life or Ability to Work

For People With HIV and Severe Disease (e.g., people with CD4 count <200 cells/mm3 or concomitant AIDS-defining illnesses), With Clinically Severe Diarrhea (≥6 liquid stools/day or bloody stool and/or accompanying fever or chills)

Duration of Therapy

Other Considerations

Treating Nontyphoidal Salmonellosis

For Invasive Disease (Suspected or Confirmed) Pending Susceptibilities

Preferred Therapy for Nontyphoidal Salmonella Gastroenteritis With or Without Bacteremia (If Susceptible)

Alternative Therapy (If Susceptible)

Duration of Therapy for Gastroenteritis Without Bacteremia

Duration of Therapy for Gastroenteritis With Bacteremia

Secondary Prophylaxis

Treating Shigellosis

Treating Campylobacteriosis

Treating Clostridioides difficile–Associated Infection

Treating Bacterial Enteric Infections During Pregnancy

Bartonellosis

Treating Bartonella Infections

Preferred Therapy For Cat Scratch Disease, Bacillary Angiomatosis, Peliosis Hepatis, Bacteremia, and Osteomyelitis

Preferred Therapy For Infections Involving the CNS

Preferred Therapy For Confirmed Bartonella Endocarditis

Preferred Therapy For Other Severe Infections (Multifocal Disease or with Clinical Decompensation)

Alternative Therapy For Confirmed Bartonella Endocarditis

Alternative Therapy For Bartonella Infections Other than Endocarditis or CNS Infections

Duration of Therapy

Indication for Long-Term Suppressive Therapy

Indications for Discontinuing Long-Term Suppressive Therapy

Other Considerations

Candidiasis

Treating Mucosal Candidiasis

Oropharyngeal Candidiasis: Initial Episodes (Duration of Therapy: 7–14 Days)

Preferred Therapy

Alternative Therapy

Esophageal Candidiasis (Duration of Therapy: 14–21 Days)

Preferred Therapy

Alternative Therapy

Uncomplicated Vulvovaginal Candidiasis

Severe or Recurrent Vulvovaginal Candidiasis

Other Considerations

Considerations During Pregnancy and Lactation

Preventing Recurrence

If the Decision Is to Use Suppressive Therapy Because of Frequent or Severe Recurrences

Considerations During Pregnancy and Lactation

Chagas Disease

Preventing Manifestations of Chagas Disease

Treating Acute or Reactivated T. cruzi Infection

Coccidioidomycosis

Preventing Coccidioidomycosis

Indications for Primary Prophylaxis/Pre-Emptive Therapy (AIII)

Preferred Therapy

Discontinuation of Primary Prophylaxis/Pre-Emptive Therapy

Treating Coccidioidomycosis

Mild-to-Moderate Pulmonary Infections

Severe Pulmonary or Extrapulmonary Infection (Except Meningitis)

Meningeal Infections (Consultation With a Specialist Is Advised [AIII])

Treatment in Pregnancy

Discontinuing Therapy

Focal Coccidioidal Pneumonia (AII)

Diffuse Pulmonary Disease or Non-Meningeal Disseminated Coccidioidomycosis

Coccidioidal Meningitis

Other Considerations

Community-Acquired Pneumonia

Preventing Streptococcus pneumoniae Infections

Indications for Pneumococcal Vaccination

Vaccination Recommendations

Preventing Influenza and Bacterial Pneumonia as a Complication of Influenza

Treating Community-Acquired Bacterial Pneumonia

General Approach to Treating Community-Acquired Bacterial Pneumonia in People With HIV

Empiric Outpatient Therapy for Patients With Non-severe CAP (Oral)

Empiric Therapy for Hospitalized Patients With Non-severe CAP

Empiric Therapy for Patients with Severe CAP

Empiric Therapy for Patients With Severe CAP at Risk of Pseudomonas Pneumonia

Empiric Therapy for Patients With Severe CAP at Risk of MRSA Pneumonia