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Updated Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-infected Adults and Adolescents
Abstract & Commentary
By Dean L. Winslow, MD, FACP, FIDSA, Chief, Division of AIDS Medicine, Santa Clara Valley Medical Center; Clinical Professor, Stanford University, School of Medicine, Section Editor, HIV, is Associate Editor for Infectious Disease Alert.
Synopsis: The U.S. Department of Health and Human Services (HHS) has updated their guidelines for the prevention and treatment of opportunistic infections (OIs) in HIV-infected adults and adolescents, effective March 24, 2009.
These guidelines were last updated for adults in 2002 and for adolescents in 2004. The document (available in pdf format through the link above) is a 209-page file containing 1,391 references which update current recommendations for the prophylaxis and treatment of HIV-related OIs. As with most guidelines published in recent years by professional societies, a well-qualified expert panel has thoroughly reviewed both new and old data and has developed a relatively comprehensive document which will be of use to physicians who treat complicated HIV patients. An attempt has been made to qualify recommendations with both the strength and quality of evidence supporting each recommendation. Obviously, it is not possible to summarize the entire document, but six major changes from previous iterations of the OI guidelines stand out in the 24 March 24, 2009 guidelines:
Lastly, it was interesting to note that these latest guidelines contain a well-reasoned discussion regarding the controversies surrounding routine screening for HPV-related anal intraepithelial neoplasia in men who have sex with men.4,5
This latest update to the OI guidelines is an important document which will be of value to all physicians who treat HIV-infected patients.