Opportunistic infections in HIV: Difference between revisions
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| Any |
| Any |
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| [[Tuberculosis]] |
| [[Tuberculosis]] |
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| 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 |
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| < |
| <500 |
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| [[Kaposi sarcoma]] (HHV-8)<br/>[[Herpes |
| [[Kaposi sarcoma]] (HHV-8)<br/>[[Herpes simplex]]<br/>[[Varicella zoster]] |
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| |
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| < |
| <300 |
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| [[Candida]]<br/>[[Molluscum contagiosum]]<br/>Diarrhea from [[microsporidia]] and [[cryptosporidia]] |
| [[Candida]]<br/>[[Molluscum contagiosum]]<br/>Diarrhea from [[microsporidia]] and [[cryptosporidia]] |
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| < |
| <200 |
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| ''[[Pneumocystis jirovecii]]'' pneumonia<br/>[[Dimorphic fungi]] |
| ''[[Pneumocystis jirovecii]]'' pneumonia<br/>[[Dimorphic fungi]] |
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| Start PJP prophylaxis (Septra SS or DS) |
| Start PJP prophylaxis (Septra SS or DS) |
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|- |
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| < |
| <100 |
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| [[Toxoplasmosis]]<br/>[[Cryptococcus]] |
| [[Toxoplasmosis]]<br/>[[Cryptococcus]] |
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| Start toxo prophylaxis if IgG positive (Septra DS) |
| Start toxo prophylaxis if IgG positive (Septra DS) |
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| < |
| <50 |
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| [[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]] |
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| Start MAC prophylaxis (azithromycin) |
| Start MAC prophylaxis (azithromycin) |
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Revision as of 22:34, 15 September 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 simplex 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
