Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

Siberry, George K.; Abzug, Mark J.; Nachman, Sharon; Brady, Michael T.; Dominguez, Kenneth L.; Handelsman, Edward; Mofenson, Lynne M.; Nesheim, Steve R.

doi:10.1097/01.inf.0000437856.09540.11

Cited by 52 publications

(30 citation statements)

References 1,295 publications

(1,526 reference statements)

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“…There is insufficient evidence to make any recommendations for routine primary prophylaxis, but specific guidance is available 35. Prophylaxis against TB can be considered for children visiting countries highly endemic for TB (see Section 10 below).…”

Section: Prophylaxis Against Opportunistic Infectionsmentioning

confidence: 99%

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

et al. 2015

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The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.

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Section: Prophylaxis Against Opportunistic Infectionsmentioning

confidence: 99%

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

et al. 2015

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“…Lorenzana et al in children, the CD4 count to consider severe immunosuppression is different from that of adults. For example, two of the patients did not have CD4 < 150 which is the cut-off point for histoplasmosis in adults [19].…”

Section: Discussionmentioning

confidence: 99%

Invasive Infections for Endemic Fungi in Pediatrics in Guatemala

Lorenzana¹,

Gómez²,

Palma³

2018

WJA

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Background: Invasive fungal infections are common opportunistic diseases in patients with AIDS, other conditions related to immunodeficiency and healthy infants. Most publications on this subject are related to industrialized countries, and in adult population, with limited data in Latin America (except for Brazil, Colombia, and Argentina), and especially in pediatric population. These patients present a variety of clinical manifestations representing a diagnostic and therapeutic challenge for the health system. Objective: The objective of the study is to describe the epidemiological and laboratory characteristics of children with invasive fungal infections in Guatemala. Methods: A review of the microbiology service database was carried out at Roosevelt Hospital in Guatemala. Positive cultures were taken from children under 15 years of age, in a period of seven years, from 2007 to 2014, with its corresponding medical history. Results: Finally, 23 isolates were documented but only 15 patients were included in the study with complete information; 10

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“…Apart from early recognition, survival of toxoplasmosis post allo‐HSCT requires both appropriate antiprotozoal chemotherapy and immune recovery . Standard treatment for cerebral toxoplasmosis consists of the combination of pyrimethamine and sulfadiazine plus administration of folinic acid for at least 6 weeks, but longer courses may be appropriate if clinical or radiologic disease is extensive, or response is incomplete at 6 weeks . While no detailed guidance exists for HSCT patients, the criteria for discontinuation of therapy in HIV‐infected patients include absence of clinical and radiographic signs and symptoms of cerebral toxoplasmosis, and a CD4 + lymphocyte percentage >15% for children <6 years of age, and >200 CD4 + lymphocytes/μL for individuals aged ≥6 years, for at least 6 months .…”

Section: Discussionmentioning

confidence: 99%

Cerebral toxoplasmosis in an adolescent post allogeneic hematopoietic stem cell transplantation: successful outcome by antiprotozoal chemotherapy and CD4⁺ T‐lymphocyte recovery

Kerl

Ehlert

Brentrup

et al. 2015

Transplant Infectious Dis

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Toxoplasmosis is a rare opportunistic infection in pediatric allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients and associated with severe T-cell deficiency. Here, we report the successful management of cerebral toxoplasmosis in a 15-year-old adolescent 4 months post allo-HSCT for non-Hodgkin lymphoma through rapid invasive diagnostics, long-term antiprotozoal chemotherapy, and an hematopoietic stem cell boost for persistently poor graft function. While supportive care and antiprotozoal chemotherapy achieved stabilization, definite improvement only occurred following recovery of CD4(+) T lymphocytes to >100 cells/μL. At 5 years after the diagnosis of toxoplasmosis, the patient is in continuing remission with normalized clinical and imaging findings.

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Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

Cited by 52 publications

References 1,295 publications

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

Invasive Infections for Endemic Fungi in Pediatrics in Guatemala

Cerebral toxoplasmosis in an adolescent post allogeneic hematopoietic stem cell transplantation: successful outcome by antiprotozoal chemotherapy and CD4⁺ T‐lymphocyte recovery

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Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

Cited by 52 publications

References 1,295 publications

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

Invasive Infections for Endemic Fungi in Pediatrics in Guatemala

Cerebral toxoplasmosis in an adolescent post allogeneic hematopoietic stem cell transplantation: successful outcome by antiprotozoal chemotherapy and CD4+ T‐lymphocyte recovery

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Cerebral toxoplasmosis in an adolescent post allogeneic hematopoietic stem cell transplantation: successful outcome by antiprotozoal chemotherapy and CD4⁺ T‐lymphocyte recovery