Opportunistic infections in HIV
From IDWiki
| CD4 | Infections | Action |
|---|---|---|
| Any | Tuberculosis | Screen for latent tuberculosis Vaccinate for pneumococcus, influenza, varicella, HPV (if appropriate), hepatitis A, and hepatitis B |
| <500 | Kaposi sarcoma (HHV-8) Herpes simplex Varicella-zoster |
|
| <300 | Candida Molluscum contagiosum Diarrhea from microsporidia and cryptosporidia |
|
| <200 | Pneumocystis jirovecii pneumonia | Start PJP prophylaxis (TMP-SMX SS or DS) |
| <150 | Dimorphic fungi | Start histoplasmosis prophylaxis if high risk (occupation or hyperendemic) (itraconazole) |
| <100 | Toxoplasmosis Cryptococcus |
Start toxoplasmosis prophylaxis if IgG positive (TMP-SMX DS) |
| <50 | Mycobacterium avium complex Cytomegalovirus, including retinitis Progressive multifocal leukoencephalopathy (PML) from JC virus |
Start MAC prophylaxis (azithromycin) |
Prophylaxis regimens
| Infection | Preferred | Alternative |
|---|---|---|
| Pneumocystis jirovecii (CD4 <200 or <14%) |
TMP-SMX 1 DS or SS PO daily | TMP-SMX 1 DS PO three times weekly |
| Dapsone 100 mg PO daily or 50 mg PO BID | ||
| Pentamidine nebs 300 mg every month | ||
| Atovaquone 1500 mg PO daily | ||
| Toxoplasma gondii (CD4 <100 and IgG positive) |
TMP-SMX 1 DS PO daily | TMP-SMX 1 DS PO three times weekly |
| TMP-SMX 1 SS PO daily | ||
| Dapsone 50 mg PO daily + pyrimethamine/leucovorin PO weekly | ||
| Atovaquone 1500 mg PO daily | ||
| Mycobacterium avium complex (CD4 <50 and not on HIV therapy) |
Azithromycin 1200 mg PO once weekly | Clarithromycin 500 mg PO BID |
| Azithromycin 600 mg PO twice weekly | ||
| Rifabutin, dose-adjusted to HIV meds | ||
| Histoplasma capsulatum (CD4 <150 and high risk) |
Itraconazole 200 mg PO once daily | |
| Coccidioides immitis (new IgM or IgG positivity in an endemic area and with CD4 <250) |
Fluconazole 400 mg PO daily |
- "High risk" for Histoplasma includes occupational exposure or residence in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years)
