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
<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
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)

Further Reading