Panel’s Recommendations

The approach to evaluation and treatment of HIV-infected children on stable combination antiretroviral therapy with suspected or confirmed influenza should be similar to that of HIV-uninfected children (AIII). HIV-infected children with evidence of moderate-to-severe immunosuppression by CD4-defined or clinical disease-defined categories may be at increased risk of influenza-related complications and should be monitored closely until illness resolution (BII). Prevention of influenza in HIV-infected children aged 6 months and older should include annual administration of trivalent inactivated influenza vaccine, according to Advisory Committee on Immunization Practices recommendations (see annual updated recommendations at http://www.cdc.gov/vaccines/pubs/acip-list.htm) (AII). Influenza-specific antiviral chemoprophylaxis should be considered for HIV-infected children based on level of immunosuppression and other preexisting co-morbidities, influenza vaccination status, and degree of exposure to suspected or confirmed influenza, according to CDC guidelines (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6001a1.htm) (BII). HIV-infected children with confirmed influenza should be considered for prompt antiviral therapy, according to CDC guidelines (see http://www.cdc.gov/flu/antivirals/ and http://www.cdc.gov/mmwr/pdf/rr/rr6001.pdf) (AII).

Rating of Recommendations: A = Strong; B = Moderate; C = Optional

Rating of Evidence: I = One or more randomized trials in children^† with clinical outcomes and/or validated endpoints; I* = One or more randomized trials in adults with clinical outcomes and/or validated laboratory endpoints with accompanying data in children^† from one or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; II = One or more well-designed, nonrandomized trials or observational cohort studies in children^† with long-term outcomes; II* = One or more well-designed, nonrandomized trials or observational studies in adults with long-term clinical outcomes with accompanying data in children^† from one or more similar nonrandomized trials or cohort studies with clinical outcome data; III = Expert opinion

^†Studies that include children or children/adolescents, but not studies limited to post-pubertal adolescents.