Opportunistic infections in HIV - Revision history

Aidan at 13:22, 22 October 2020

2020-10-22T13:22:39Z

← Older revision		Revision as of 13:22, 22 October 2020
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	{\| class="wikitable"		{\| class="wikitable"
	! CD4		!CD4
	! Infections		!Infections
	! Action		!Action
	\|-		\|-
	\| Any		\|Any
	\| [[Tuberculosis]]		\|[[Tuberculosis]]
	\| Screen for [[latent tuberculosis]]<br/>Vaccinate for pneumococcus, influenza, varicella, HPV (if appropriate), ~~Hepatitis~~ A, and ~~Hepatitis~~ B		\|Screen for [[latent tuberculosis]]<br />Vaccinate for [[pneumococcus]], [[influenza]], [[varicella]], [[HPV]] (if appropriate), [[hepatitis A]], and [[hepatitis B]]
	\|-		\|-
	\| <500		\|<500
	\| [[Kaposi sarcoma]] (HHV-8)<br/>[[Herpes simplex]]<br/>[[Varicella-zoster]]		\|[[Kaposi sarcoma]] (HHV-8)<br />[[Herpes simplex]]<br />[[Varicella-zoster]]
	\|		\|
	\|-		\|-
	\| <300		\|<300
	\| [[Candida]]<br/>[[Molluscum contagiosum]]<br/>Diarrhea from [[microsporidia]] and [[cryptosporidia]]		\|[[Candida]]<br />[[Molluscum contagiosum]]<br />Diarrhea from [[microsporidia]] and [[cryptosporidia]]
	\|		\|
	\|-		\|-
	\| <200		\|<200
	\| ''[[Pneumocystis jirovecii]]'' pneumonia		\|''[[Pneumocystis jirovecii]]'' pneumonia
	\| Start PJP prophylaxis (~~Septra~~ SS or DS)		\|Start [[PJP]] prophylaxis ([[TMP-SMX]] SS or DS)
	\|-		\|-
	\| <150		\|<150
	\| [[Dimorphic fungi]]		\|[[Dimorphic fungi]]
	\| Start histoplasmosis prophylaxis if high risk (occupation or hyperendemic) (~~itra~~)		\|Start [[histoplasmosis]] prophylaxis if high risk (occupation or hyperendemic) ([[itraconazole]])
	\|-		\|-
	\| <100		\|<100
	\| [[Toxoplasmosis]]<br/>[[Cryptococcus]]		\|[[Toxoplasmosis]]<br />[[Cryptococcus]]
	\| Start ~~toxo~~ prophylaxis if IgG positive (~~Septra~~ DS)		\|Start [[toxoplasmosis]] prophylaxis if IgG positive ([[TMP-SMX]] DS)
	\|-		\|-
	\| <50		\|<50
	\| [[Mycobacterium avium complex]]<br/>[[Cytomegalovirus]], including retinitis<br/>Progressive multifocal leukoencephalopathy (PML) from [[JC virus]]		\|[[Mycobacterium avium complex]]<br />[[Cytomegalovirus]], including retinitis<br />Progressive multifocal leukoencephalopathy (PML) from [[JC virus]]
	\| Start MAC prophylaxis (azithromycin)		\|Start [[Mycobacterium avium complex\|MAC]] prophylaxis ([[azithromycin]])
	\|}		\|}

	== Prophylaxis regimens ==		==Prophylaxis regimens==
	{\| class="wikitable"		{\| class="wikitable"
	! Infection !! Preferred !! Alternative		!Infection!!Preferred!!Alternative
	\|-		\|-
	\| rowspan=4 \| ''[[Pneumocystis jirovecii]]''<br/>(CD4 <200 or <14%)		\| rowspan="4" \|''[[Pneumocystis jirovecii]]''<br />(CD4 <200 or <14%)
	\| rowspan=4 \| [[TMP-SMX]] 1 DS or SS PO daily		\| rowspan="4" \|[[TMP-SMX]] 1 DS or SS PO daily
	\| [[TMP-SMX]] 1 DS PO three times weekly		\|[[TMP-SMX]] 1 DS PO three times weekly
	\|-		\|-
	\| [[Dapsone]] 100 mg PO daily or 50 mg PO BID		\|[[Dapsone]] 100 mg PO daily or 50 mg PO BID
	\|-		\|-
	\| [[Pentamidine]] nebs 300 mg every month		\|[[Pentamidine]] nebs 300 mg every month
	\|-		\|-
	\| [[Atovaquone]] 1500 mg PO daily		\|[[Atovaquone]] 1500 mg PO daily
	\|-		\|-
	\| rowspan=4 \| ''[[Toxoplasma gondii]]''<br/>(CD4 <100 and IgG positive)		\| rowspan="4" \|''[[Toxoplasma gondii]]''<br />(CD4 <100 and IgG positive)
	\| rowspan=4 \| [[TMP-SMX]] 1 DS PO daily		\| rowspan="4" \|[[TMP-SMX]] 1 DS PO daily
	\| [[TMP-SMX]] 1 DS PO three times weekly		\|[[TMP-SMX]] 1 DS PO three times weekly
	\|-		\|-
	\| [[TMP-SMX]] 1 SS PO daily		\|[[TMP-SMX]] 1 SS PO daily
	\|-		\|-
	\| [[Dapsone]] 50 mg PO daily + pyrimethamine/leucovorin PO weekly		\|[[Dapsone]] 50 mg PO daily + pyrimethamine/leucovorin PO weekly
	\|-		\|-
	\| [[Atovaquone]] 1500 mg PO daily		\|[[Atovaquone]] 1500 mg PO daily
	\|-		\|-
	\| rowspan=3 \| ''[[Mycobacterium avium complex]]''<br/>(CD4 <50 and ''not'' on HIV therapy)		\| rowspan="3" \|''[[Mycobacterium avium complex]]''<br />(CD4 <50 and ''not'' on HIV therapy)
	\| rowspan=3 \| [[Azithromycin]] 1200 mg PO once weekly		\| rowspan="3" \|[[Azithromycin]] 1200 mg PO once weekly
	\| [[Clarithromycin]] 500 mg PO BID		\|[[Clarithromycin]] 500 mg PO BID
	\|-		\|-
	\| [[Azithromycin]] 600 mg PO twice weekly		\|[[Azithromycin]] 600 mg PO twice weekly
	\|-		\|-
	\| [[Rifabutin]], dose-adjusted to HIV meds		\|[[Rifabutin]], dose-adjusted to HIV meds
	\|-		\|-
	\| ''[[Histoplasma capsulatum]]''<br/>(CD4 <150 and high risk)		\|''[[Histoplasma capsulatum]]''<br />(CD4 <150 and high risk)
	\| [[Itraconazole]] 200 mg PO once daily		\|[[Itraconazole]] 200 mg PO once daily
	\|		\|
	\|-		\|-
	\| ''[[Coccidioides immitis]]''<br/>(new IgM or IgG positivity in an endemic area and with CD4 <250)		\|''[[Coccidioides immitis]]''<br />(new IgM or IgG positivity in an endemic area and with CD4 <250)
	\| [[Fluconazole]] 400 mg PO daily		\|[[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)		* "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 ==		==Further Reading==

	* [https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-opportunistic-infection/0 AIDSinfo Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents]		*[https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-opportunistic-infection/0 AIDSinfo Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents]

	[[Category:HIV]]		[[Category:HIV]]

Aidan: Text replacement - "Varicella zoster" to "Varicella-zoster"

2020-08-04T00:27:34Z

Text replacement - "Varicella zoster" to "Varicella-zoster"

← Older revision		Revision as of 00:27, 4 August 2020
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	\|-		\|-
	\| <500		\| <500
	\| [[Kaposi sarcoma]] (HHV-8)<br/>[[Herpes simplex]]<br/>[[Varicella zoster]]		\| [[Kaposi sarcoma]] (HHV-8)<br/>[[Herpes simplex]]<br/>[[Varicella-zoster]]
	\|		\|
	\|-		\|-

Aidan: /* Prophylaxis regimens */ clarified MAC proph

2020-01-22T01:57:38Z

Prophylaxis regimens: clarified MAC proph

← Older revision		Revision as of 01:57, 22 January 2020
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	\| [[Atovaquone]] 1500 mg PO daily		\| [[Atovaquone]] 1500 mg PO daily
	\|-		\|-
	\| rowspan=3 \| ''[[Mycobacterium avium complex]]''<br/>(CD4 <50 and ''not'' on therapy)		\| rowspan=3 \| ''[[Mycobacterium avium complex]]''<br/>(CD4 <50 and ''not'' on HIV therapy)
	\| rowspan=3 \| [[Azithromycin]] 1200 mg PO once weekly		\| rowspan=3 \| [[Azithromycin]] 1200 mg PO once weekly
	\| [[Clarithromycin]] 500 mg PO BID		\| [[Clarithromycin]] 500 mg PO BID

Aidan: /* Prophylaxis regimens */ typo

2020-01-22T01:57:13Z

Prophylaxis regimens: typo

← Older revision		Revision as of 01:57, 22 January 2020
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	\| ''[[Coccidioides immitis]]''<br/>(new IgM or IgG positivity in an endemic area and with CD4 <250)		\| ''[[Coccidioides immitis]]''<br/>(new IgM or IgG positivity in an endemic area and with CD4 <250)
	\| [[Fluconazole]] 400 mg PO daily		\| [[Fluconazole]] 400 mg PO daily
			\|
	)
	\|}		\|}

Aidan: /* Prophylaxis regimens */ added cocci

2020-01-22T01:56:56Z

Prophylaxis regimens: added cocci

← Older revision		Revision as of 01:56, 22 January 2020
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	! Infection !! Preferred !! Alternative		! Infection !! Preferred !! Alternative
	\|-		\|-
	\| rowspan=4 \| ''[[Pneumocystis jirovecii]]''<br/>(CD4 <200)		\| rowspan=4 \| ''[[Pneumocystis jirovecii]]''<br/>(CD4 <200 or <14%)
	\| rowspan=4 \| [[TMP-SMX]] 1 DS or SS PO daily		\| rowspan=4 \| [[TMP-SMX]] 1 DS or SS PO daily
	\| [[TMP-SMX]] 1 DS PO three times weekly		\| [[TMP-SMX]] 1 DS PO three times weekly
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	\| [[Itraconazole]] 200 mg PO once daily		\| [[Itraconazole]] 200 mg PO once daily
	\|		\|
			\|-
			\| ''[[Coccidioides immitis]]''<br/>(new IgM or IgG positivity in an endemic area and with CD4 <250)
			\| [[Fluconazole]] 400 mg PO daily
			)
	\|}		\|}

Aidan: /* Prophylaxis regimens */

2020-01-22T01:50:12Z

Prophylaxis regimens

← Older revision		Revision as of 01:50, 22 January 2020
Line 57:		Line 57:
	\| [[Atovaquone]] 1500 mg PO daily		\| [[Atovaquone]] 1500 mg PO daily
	\|-		\|-
	\| rowspan=3 \| ''[[Mycobacterium avium complex]]''<br/>(CD4 <50)		\| rowspan=3 \| ''[[Mycobacterium avium complex]]''<br/>(CD4 <50 and ''not'' on therapy)
	\| rowspan=3 \| [[Azithromycin]] 1200 mg PO once weekly		\| rowspan=3 \| [[Azithromycin]] 1200 mg PO once weekly
	\| [[Clarithromycin]] 500 mg PO BID		\| [[Clarithromycin]] 500 mg PO BID

Aidan: /* Prophylaxis regimens */

2020-01-22T01:04:30Z

Prophylaxis regimens

Aidan: /* Prophylaxis regimens */ changed to table layout

2020-01-22T01:03:04Z

Prophylaxis regimens: changed to table layout

← Older revision		Revision as of 01:03, 22 January 2020
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	== Prophylaxis regimens ==		== Prophylaxis regimens ==
			{\| class="wikitable"
			! Infection !! Preferred !! Alternative
			\|-
		⚫	\| rowspan=4 \| ''[[Pneumocystis jirovecii]]'' (CD4 <200)
		⚫	\| rowspan=4 \| [[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
			\|-
		⚫	\| rowspan=4 \| ''[[Toxoplasma gondii]]'' (CD4 <100 and IgG positive)
		⚫	\| rowspan=4 \| [[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
			\|-
		⚫	\| rowspan=3 \| ''[[Mycobacterium avium complex]]'' (CD4 <50)
		⚫	\| rowspan=3 \| [[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
			\|
			\|}

		⚫	"High risk" for ''Histoplasma'' includes occupational exposure or residence in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years)
⚫	* ''[[Pneumocystis jirovecii]]'' (CD4 <200)
⚫	** ~~Preferred:~~ [[TMP-SMX]] 1 DS or SS PO daily
	** Alternate
⚫	~~***~~ [[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)
⚫	** ~~Preferred:~~ [[TMP-SMX]] 1 DS PO daily
	** Alternate
⚫	~~***~~ [[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)
⚫	** ~~Preferred:~~ [[Azithromycin]] 1200 mg PO once weekly
	** Alternate
⚫	~~***~~ [[Clarithromycin]] 500 mg PO BID
⚫	~~***~~ [[Azithromycin]] 600 mg PO twice weekly
⚫	~~***~~ [[Rifabutin]], dose-adjusted to HIV meds
⚫	* [[Histoplasma capsulatum]] (CD4 <150 and high risk)
⚫	** "High risk" includes occupational exposure or residence in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years)
⚫	** Preferred: [[Itraconazole]] 200 mg PO once daily

	== Further Reading ==		== Further Reading ==

Aidan: /* Prophylaxis regimens */ links

2019-11-21T11:27:16Z

Prophylaxis regimens: links

← Older revision		Revision as of 11:27, 21 November 2019
Line 36:		Line 36:

	* ''[[Pneumocystis jirovecii]]'' (CD4 <200)		* ''[[Pneumocystis jirovecii]]'' (CD4 <200)
	** Preferred: TMP-SMX 1 DS or SS PO daily		** Preferred: [[TMP-SMX]] 1 DS or SS PO daily
	** Alternate		** Alternate
	*** TMP-SMX 1 DS PO three times weekly		*** [[TMP-SMX]] 1 DS PO three times weekly
	*** Dapsone 100 mg PO daily or 50 mg PO BID		*** [[Dapsone]] 100 mg PO daily or 50 mg PO BID
	*** Pentamidine nebs 300 mg every month		*** [[Pentamidine]] nebs 300 mg every month
	*** Atovaquone 1500 mg PO daily		*** [[Atovaquone]] 1500 mg PO daily
	* ''[[Toxoplasma gondii]]'' (CD4 <100 and IgG positive)		* ''[[Toxoplasma gondii]]'' (CD4 <100 and IgG positive)
	** Preferred: TMP-SMX 1 DS PO daily		** Preferred: [[TMP-SMX]] 1 DS PO daily
	** Alternate		** Alternate
	*** TMP-SMX 1 DS PO three times weekly		*** [[TMP-SMX]] 1 DS PO three times weekly
	*** TMP-SMX 1 SS PO daily		*** [[TMP-SMX]] 1 SS PO daily
	*** Dapsone 50 mg PO daily + pyrimethamine/leucovorin PO weekly		*** [[Dapsone]] 50 mg PO daily + pyrimethamine/leucovorin PO weekly
	*** Atovaquone 1500 mg PO daily		*** [[Atovaquone]] 1500 mg PO daily
	* ''[[Mycobacterium avium complex]]'' (CD4 <50)		* ''[[Mycobacterium avium complex]]'' (CD4 <50)
	** Preferred: Azithromycin 1200 mg PO once weekly		** Preferred: [[Azithromycin]] 1200 mg PO once weekly
	** Alternate		** Alternate
	*** Clarithromycin 500 mg PO BID		*** [[Clarithromycin]] 500 mg PO BID
	*** Azithromycin 600 mg PO twice weekly		*** [[Azithromycin]] 600 mg PO twice weekly
	*** Rifabutin, dose-adjusted to HIV meds		*** [[Rifabutin]], dose-adjusted to HIV meds
	* [[Histoplasma capsulatum]] (CD4 <150 and high risk)		* [[Histoplasma capsulatum]] (CD4 <150 and high risk)
	** "High risk" includes occupational exposure or residence in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years)		** "High risk" includes occupational exposure or residence in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years)
	** Preferred: Itraconazole 200 mg PO once daily		** Preferred: [[Itraconazole]] 200 mg PO once daily

	== Further Reading ==		== Further Reading ==

Aidan: typo

2019-09-25T18:04:06Z

typo

← Older revision		Revision as of 18:04, 25 September 2019
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	\| Start PJP prophylaxis (Septra SS or DS)		\| Start PJP prophylaxis (Septra SS or DS)
	\|-		\|-
	\| < 150		\| <150
	\| [[Dimorphic fungi]]		\| [[Dimorphic fungi]]
	\| Start histoplasmosis prophylaxis if high risk (occupation or hyperendemic) (itra)		\| Start histoplasmosis prophylaxis if high risk (occupation or hyperendemic) (itra)

← Older revision		Revision as of 01:04, 22 January 2020
Line 37:		Line 37:
	! Infection !! Preferred !! Alternative		! Infection !! Preferred !! Alternative
	\|-		\|-
	\| rowspan=4 \| ''[[Pneumocystis jirovecii]]'' (CD4 <200)		\| rowspan=4 \| ''[[Pneumocystis jirovecii]]''<br/>(CD4 <200)
	\| rowspan=4 \| [[TMP-SMX]] 1 DS or SS PO daily		\| rowspan=4 \| [[TMP-SMX]] 1 DS or SS PO daily
	\| [[TMP-SMX]] 1 DS PO three times weekly		\| [[TMP-SMX]] 1 DS PO three times weekly
Line 47:		Line 47:
	\| [[Atovaquone]] 1500 mg PO daily		\| [[Atovaquone]] 1500 mg PO daily
	\|-		\|-
	\| rowspan=4 \| ''[[Toxoplasma gondii]]'' (CD4 <100 and IgG positive)		\| rowspan=4 \| ''[[Toxoplasma gondii]]''<br/>(CD4 <100 and IgG positive)
	\| rowspan=4 \| [[TMP-SMX]] 1 DS PO daily		\| rowspan=4 \| [[TMP-SMX]] 1 DS PO daily
	\| [[TMP-SMX]] 1 DS PO three times weekly		\| [[TMP-SMX]] 1 DS PO three times weekly
Line 57:		Line 57:
	\| [[Atovaquone]] 1500 mg PO daily		\| [[Atovaquone]] 1500 mg PO daily
	\|-		\|-
	\| rowspan=3 \| ''[[Mycobacterium avium complex]]'' (CD4 <50)		\| rowspan=3 \| ''[[Mycobacterium avium complex]]''<br/>(CD4 <50)
	\| rowspan=3 \| [[Azithromycin]] 1200 mg PO once weekly		\| rowspan=3 \| [[Azithromycin]] 1200 mg PO once weekly
	\| [[Clarithromycin]] 500 mg PO BID		\| [[Clarithromycin]] 500 mg PO BID
Line 65:		Line 65:
	\| [[Rifabutin]], dose-adjusted to HIV meds		\| [[Rifabutin]], dose-adjusted to HIV meds
	\|-		\|-
	\| ''[[Histoplasma capsulatum]]'' (CD4 <150 and high risk)		\| ''[[Histoplasma capsulatum]]''<br/>(CD4 <150 and high risk)
	\| [[Itraconazole]] 200 mg PO once daily		\| [[Itraconazole]] 200 mg PO once daily
	\|		\|