Opportunistic infections in HIV: Difference between revisions

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|-
|-
| 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
|-
|-
| &lt; 500
| &lt; 500
| Kaposi sarcoma (HHV-8)<br/>Herpes simples<br/>Varicella zoster
| [[Kaposi sarcoma]] (HHV-8)<br/>[[Herpes simples]]<br/>[[Varicella zoster]]
|
|
|-
|-
| &lt; 300
| &lt; 300
| Candida<br/>Molluscum contagiosum<br/>Diarrhea from microsporidia and cryptosporidia
| [[Candida]]<br/>[[Molluscum contagiosum]]<br/>Diarrhea from [[microsporidia]] and [[cryptosporidia]]
|
|
|-
|-
| &lt; 200
| &lt; 200
| ''Pneumocystis jirovecii'' pneumonia<br/>Endemic fungi
| ''[[Pneumocystis jirovecii]]'' pneumonia<br/>[[Dimorphic fungi]]
| Start PJP prophylaxis (Septra SS or DS)
| Start PJP prophylaxis (Septra SS or DS)
|-
|-
| &lt; 100
| &lt; 100
| Toxoplasmosis<br/>Cryptococcus
| [[Toxoplasmosis]]<br/>[[Cryptococcus]]
| Start toxo prophylaxis if IgG positive (Septra DS)
| Start toxo prophylaxis if IgG positive (Septra DS)
|-
|-
| &lt; 50
| &lt; 50
| Mycobacterium avium complex (MAC)<br/>Cytomegalovirus (CMV), 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 MAC prophylaxis (azithromycin)
|}
|}

Revision as of 09:37, 16 August 2019

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 simples
Varicella zoster
< 300 Candida
Molluscum contagiosum
Diarrhea from microsporidia and cryptosporidia
< 200 Pneumocystis jirovecii pneumonia
Dimorphic fungi
Start PJP prophylaxis (Septra SS or DS)
< 100 Toxoplasmosis
Cryptococcus
Start toxo prophylaxis if IgG positive (Septra DS)
< 50 Mycobacterium avium complex
Cytomegalovirus, including retinitis
Progressive multifocal leukoencephalopathy (PML) from JC virus
Start MAC prophylaxis (azithromycin)

Prophylaxis regimens

  • 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

Further Reading