Guidelines for Prevention Guidelines for Prevention and Treatment of and Treatment of Opportunistic Infections Opportunistic Infections among HIV-Infected Children among HIV-Infected Children Bacterial Infections Bacterial Infections Recommendations from Centers for Disease Control and Prevention, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric
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Guidelines for Prevention and Treatment of Opportunistic Infections among HIV-Infected Children Bacterial Infections Recommendations from Centers for Disease.
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Guidelines for Prevention and Guidelines for Prevention and Treatment of Opportunistic Infections Treatment of Opportunistic Infections among HIV-Infected Childrenamong HIV-Infected Children
Bacterial InfectionsBacterial Infections
Recommendations from Centers for Disease Control and Prevention,
the National Institutes of Health, the HIV Medicine Association of
the Infectious Diseases Society of America, the Pediatric Infectious
Diseases Society, and the American Academy of Pediatrics
July 20092 www.aidsect.org
These slides were developed using the April 2008 Guidelines. The intended audience is clinicians involved in the care of patients with HIV.
Users are cautioned that, because of the rapidly changing field of HIV care, this information could become out of date quickly. Finally, it is intended that these slides be used as prepared, without changes in either content or attribution. Users are asked to honor this intent. Expert opinion should be sought for complex treatment regimens.
Most common infection in pre-HAART era (15/100 child years)
Because of difficulties in obtaining appropriate diagnostic specimens, bacterial pneumonia is often a presumptive diagnosis in a child with fever, pulmonary symptoms, and an abnormal chest radiogram
Bacteremia more common in HIV-infected children with pneumonia
Immunocompromised individuals who experience treatment failure should be re-treated for 4-6 months
Immunocompromised HIV-infected adults who experience relapse have been treated with long-term suppression with doxycycline or a macrolide when CD4 counts are <200 cells/µL
There are no data for children
July 200925 www.aidsect.org
Syphilis: Syphilis: EpidemiologyEpidemiology
Perinatal transmission of Treponema pallidum at any stage of pregnancy or during delivery
Illicit drug use during pregnancy increases risk of maternal and congenital syphilis
Rate of congenital syphilis 50 times greater among infants born to HIV-infected mothers
Half of new infections are in women 15-24 years of age
Untreated early syphilis in pregnancy leads to spontaneous abortion, stillbirth, hydrops, preterm delivery, death in up to 40% of pregnancies
47% of infants born to mothers with inadequately treated syphilis have clinical, radiographic, or laboratory findings consistent with congenital syphilis
60% of infants with congenital syphilis have hepatomegaly, jaundice, skin rash, nasal discharge, anemia, thrombocytopenia, osteitis, periostitis, osteochondritis, or pseudoparalysis
Late manifestations include mental retardation, keratitis, deafness, frontal bossing, Hutchinson teeth, saddle nose, Clutton joints
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Syphilis: Syphilis: DiagnosisDiagnosis
Use combination of physical, radiologic, serologic, and direct microscopic results, as standard serologic tests detect only IgG
All infants born to mothers with reactive nontreponemal and treponemal tests should be evaluated with a quantitative nontreponemal test (eg, slide test, RPR, automated reagin test)
July 200929 www.aidsect.org
Syphilis: Syphilis: Diagnosis Diagnosis (2)(2)
Darkfield microscopy or direct fluorescent antibody staining
Presumptive diagnosis – any infant, regardless of physical findings, born to an untreated or inadequately treated mother with syphilis
Treat all infants whose mothers have untreated or inadequately treated syphilis; not treated or initiated treatment 4 weeks prior to delivery
Treat if mother treated with penicillin but no 4-fold decrease in nontreponemal antibody titer, or a 4-fold increase suggesting relapse or reinfection
Treat infants regardless of maternal history if examination suggests syphilis; darkfield or fluorescent antibody test positive or nontreponemal serologic titer = 4-fold higher than maternal level (A II)
Aqueous crystalline penicillin G: 100,000-150,000 units/kg/day given as 50,000 units/kg/dose IV Q12H for 7 days, followed by Q8H for a total of 10 days (A II)
Diagnosis after 1 month of age, increase dosage to 50,000 units/kg IV Q6H for 10 days
Treat acquired syphilis with single dose of benzathine penicillin G 50,000 units/kg IM
Treat late latent disease with benzathine penicillin G 50,000 units/kg IM once weekly for 3 doses (A III)
Alternative therapies among HIV-infected patients have not been evaluated
Treat neurosyphilis with aqueous penicillin G 200,000 to 300,000 units/kg IV Q6H for 10-14 days
Follow up with examinations at 1, 2, 3, 6, and 12 months and serologic tests at 3, 6, and 12 months; if titers continue to be positive or increase, consider retreatment (A III)
July 200935 www.aidsect.org
This presentation was prepared by Arthur Ammann, MD, Clinical Professor of Pediatrics University of California and President of Global Strategies for HIV Prevention for the AETC National Resource Center, in July 2009
See the AETC NRC website for the most current version of this presentation: