On April 23, 2025, the United States Department of Health and Human Services (DHHS) released the latest edition of the “Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV.” These guidelines, focusing on opportunistic infections (OI) have been continuously updated since 2009, with each chapter undergoing quarterly review by the guidelines committee. Updates are promptly published as often as deemed appropriate by the guidelines committee, making this document a valuable resource to clinicians, other health care providers, people with HIV, and policymakers in the United States. 

The primary objective of these guidelines is to offer comprehensive guidance to HIV care practitioners and other stakeholders on the most effective strategies for preventing and managing HIV-related opportunistic infections in adults and adolescents in the United States.

Highlighted below are some key changes in the current version of the guideline. Please note that this summary does not encompass all of the changes. For a comprehensive list, please refer to the summary provided here or access the full text guideline located here. Let's get started!

Key Changes (April 23, 2025)

The following sections have been updated in the current version of the guideline.

Cystoisosporiasis (Formerly Isosporiasis)

  • Epidemiology information has been updated to include new tropical and subtropical regions identified as endemic for Cystoisospora belli.
  • Diagnosis section has incorporated new information on the use of polymerase chain reaction (PCR), for the diagnosing of cystoisosporiasis. It is noted that it offers advantages for faster detection and also has the ability to detect multiple parasites simultaneously.
  • Recommendations regarding the use of primary prophylaxis have been updated with more detailed information.
  • Updates have been made to the preferred and alternative regimens for treatment and chronic maintenance therapy.

Human Herpesvirus-8 Disease

  • More detailed information has been provided on diagnosing diseases associated with human herpesvirus-8 (HHV-8).
  • Treatment regimens for Kaposi sarcoma (KS), multicentric Castleman’s disease, primary effusion lymphoma, and HHV-8 diffuse large B-cell lymphoma have been updated.
  • Further information has been included regarding the treatment of Kaposi's sarcoma inflammatory cytokine syndrome. The recommendation includes antiretroviral therapy (ART) in combination with rituximab and chemotherapy for patients with concurrent Kaposi's sarcoma, after excluding multicentric Castleman disease (MCD) and primary effusion lymphoma (PEL).

Antimicrobial Dosing Recommendations for Renal Insufficiency (Table 6)

  • Table 6, located here, has been revised to include clinical discretion when adjusting doses of lamivudine and emtricitabine in patients with renal insufficiency. 
  • It now aligns with the dosing recommendations outlined in the Adult and Adolescent Antiretroviral Guidelines from the US Department of Health and Human Services.

This evolving document embodies the most up-to-date evidence and best practices for the management of opportunistic infections in individuals with HIV.  By maintaining this as a living document, clinicians can stay current and ensure optimal outcomes for this vulnerable population.  


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