The clinical management of pulmonary opportunistic infections 2024
British HIV Association guidelines on the management of opportunistic infection in people living with HIV:
The clinical management of pulmonary opportunistic infections 2024
Introduction
With improvements in the HIV testing and treatment cascade and reductions in the prevalence of advanced HIV, the incidence of ‘classic’ pulmonary opportunistic infections is lower, and so less frequently encountered by physicians. In addition, chronic lung diseases such as chronic obstructive pulmonary disease have become more common in people living with HIV taking antiretroviral therapy.
HIV continues to alter the lung environment through the impact of persistent viral replication, inflammation, oxidative stress, alterations in the microbiome and the modifiable effects of cigarette smoking. This means that the relative contribution of common community-acquired respiratory infections is greater and these can present with more severe disease necessitating different approaches to prevention compared with individuals without HIV. Accordingly, as well as pneumonia caused by Pneumocystis jirovecii, in these guidelines we consider bacterial pneumonia and influenza. Fungal pneumonias and cytomegalovirus, the incidence rates of which are low, are also considered. Each section contains specific information about the epidemiology, presentation, treatment and prophylaxis of opportunistic infections.
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Additional information
General methodology
Supporting people living with HIV and opportunistic infections
Consultation comments
Comments received by the BHIVA Secretariat during the public consultation process
Declaration of interests
Declaration of interests from writing group members
Non-technical summary
Please note: The non-technical summary is less detailed than the full guideline and if you are reading this because it is relevant to your own healthcare, please do discuss any concerns or questions with your healthcare professionals.
Writing group
Prof David Dockrell (Chair), Dr Ronan Breen, Dr Paul Collini, Prof Marc Lipman, Prof Robert Miller
UK-CAB (community) members are involved in the writing and/or proofreading of each chapter, and where not listed as authors are the UK-CAB members of the Guidelines Subcommittee.
Peer review
The guidelines were peer reviewed by Prof Derek Macallan, St George’s, University of London, and Prof Martin Wiselka, University Hospitals of Leicester NHS Trust.
Guideline updates and date of next review
The guidelines are scheduled for full review by 2029.