Opportunistic Infections, Treatment in Children

Please click on the link below to access the most up-to-date version of this guideline. The content on this page is currently being updated to align with the latest publication. Always check the version number at the bottom of the screen to confirm which version you are using.

Click here to access the Primary Health Care - PHC Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS) - 26 February 2026

---

Candidiasis, Oral (thrush), Recurrent

Candidiasis, Oesophageal

Diarrhoea, HIV-Associated

Pneumonia

Measles and Chickenpox

Skin Conditions

Tuberculosis (TB)

---

CANDIDIASIS, ORAL (THRUSH), RECURRENT

B20.4

MEDICINE TREATMENT

• Nystatin suspension, oral, 100 000 IU/mL, 0.5 mL after each feed.
  • Keep in contact with the affected area for as long as possible prior to swallowing.
  • In the older child, ask child to swirl in the mouth, prior to swallowing.
  • In the infant, advise caregiver to apply to front of the mouth and spread over the oral mucosa with a clean finger.
  • Continue for 48 hours after resolution of symptoms.

If there is oral candidiasis and the child cannot swallow, this indicates the presence of oesophageal candidiasis. See Candidiasis, Oesophageal (below).

CANDIDIASIS, OESOPHAGEAL

B20.4

MEDICINE TREATMENT

Fluconazole, oral, 6 mg/kg once daily for 21 days. See dosing table.

DIARRHOEA, HIV-ASSOCIATED

See Diarrhoea.

PNEUMONIA

See Respiratory infections.

MEASLES AND CHICKENPOX

Refer all patients.

SKIN CONDITIONS

These are common and include scabies, seborrhoeic eczema and others.
See Chapter: Skin conditions.
If no response to care as directed in the chapter, refer.

TUBERCULOSIS (TB)

A15.0-6/A15.7-9/A16.0-5/A16.7-9/A17.0-1/A17.8-9/A18.0-8/A19.0-2/A19.8-9 + B20.0

DESCRIPTION

TB and HIV are often comorbid conditions. Exclude TB in all patients before starting ART.
See Pulmonary Tuberculosis, in Children.

Re-evaluate the risk for TB and TB contact at each visit on history (including contact history) and clinical examination.

TB should be considered early in non-resolving pneumonias. At every follow up visit, ask about symptoms of cough, night sweats, fever, TB contacts and check for failure to thrive.

Refer early for diagnostic evaluation. If TB is suspected:

• Chest radiograph (CXR)
• GeneXpert on any relevant specimen including stool
• Culture on respiratory or appropriate specimen
• Urine-LAM. If no sample obtained, continue evaluation

MEDICINE TREATMENT

TB prophylaxis Z29.2 + (B24)

Give TB prophylaxis to all HIV-infected children in whom no evidence of TB disease is present and who are:

• Exposed to a close contact with infectious pulmonary TB or
• TST-positive (this test is only reliable the first time TPT is given).
• Isoniazid, oral, 10 mg/kg/dose once daily for 6 months.
  • Maximum dose 300 mg daily.
  • See TB chemoprophylaxis/Isoniazid Preventive Therapy (IPT) in Children.

Repeat course if an HIV-infected patient, irrespective of age, is re-exposed to a TB contact at any point after completing TB treatment or prophylaxis.

Refer if patient has been exposed to a known MDR or XDR-TB source case or the contact case has failed standard TB treatment.

TB treatment

If the child is not yet on ART:

• TB treatment and ART can be started at the same time, with the exception of children with TB meningitis – start ART at 4 weeks regardless of CD4 count to avoid IRIS.
• Assess the child for possible disseminated TB disease.
• Be aware of the possibility of Immune Reconstitution Inflammatory Syndrome (IRIS).

If the child is already on ART:

• Commence TB treatment, considering possible drug interactions and the need for ART dosage adaptations.

If the child needs to take concomitant ART and rifampicin-containing treatment:

• Dolutegravir: use dolutegravir twice daily.
• Efavirenz: use the normal recommended dosage as per dosing table.
• Abacavir and lamivudine: no dose adjustment required.
• Lopinavir/ritonavir: Refer to the dosage table for the ritonavir boosting doses
  • Avoid using double-dose lopinavir/ritonavir solution in young children. If ritonavir powder is not available, consult an expert.
• Give pyridoxine (vitamin B6) to all children on TB and ART, to avoid development of peripheral neuropathy.

Click here to access the pdf.

---

Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 2.1_09 December 2024

Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV AND AIDS)_ 11.8 Opportunistic Infections, Treatment in Children