Opportunistic infections in HIV: Difference between revisions
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!CD4 |
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!Infections |
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!Action |
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|Any |
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|[[Tuberculosis]] |
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|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 simplex]]<br />[[Varicella-zoster]] |
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|<300 |
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|[[Candida]]<br />[[Molluscum contagiosum]]<br />Diarrhea from [[microsporidia]] and [[cryptosporidia]] |
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|<200 |
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|''[[Pneumocystis jirovecii]]'' pneumonia |
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|Start [[PJP]] prophylaxis ([[TMP-SMX]] SS or DS) |
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|<150 |
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|[[Dimorphic fungi]] |
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|Start [[histoplasmosis]] prophylaxis if high risk (occupation or hyperendemic) ([[itraconazole]]) |
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|<100 |
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|[[Toxoplasmosis]]<br />[[Cryptococcus]] |
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|Start [[toxoplasmosis]] prophylaxis if IgG positive ([[TMP-SMX]] 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]] |
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|Start [[Mycobacterium avium complex|MAC]] prophylaxis ([[azithromycin]]) |
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== |
==Prophylaxis regimens== |
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!Infection!!Preferred!!Alternative |
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| rowspan="4" |''[[Pneumocystis jirovecii]]''<br />(CD4 <200 or <14%) |
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| rowspan="4" |[[TMP-SMX]] 1 DS or SS PO daily |
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|[[TMP-SMX]] 1 DS PO three times weekly |
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|[[Dapsone]] 100 mg PO daily or 50 mg PO BID |
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|[[Pentamidine]] nebs 300 mg every month |
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|[[Atovaquone]] 1500 mg PO daily |
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| rowspan="4" |''[[Toxoplasma gondii]]''<br />(CD4 <100 and IgG positive) |
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| rowspan="4" |[[TMP-SMX]] 1 DS PO daily |
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|[[TMP-SMX]] 1 DS PO three times weekly |
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|[[TMP-SMX]] 1 SS PO daily |
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|[[Dapsone]] 50 mg PO daily + pyrimethamine/leucovorin PO weekly |
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|[[Atovaquone]] 1500 mg PO daily |
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| rowspan="3" |''[[Mycobacterium avium complex]]''<br />(CD4 <50 and ''not'' on HIV therapy) |
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| rowspan="3" |[[Azithromycin]] 1200 mg PO once weekly |
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|[[Clarithromycin]] 500 mg PO BID |
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|[[Azithromycin]] 600 mg PO twice weekly |
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|[[Rifabutin]], dose-adjusted to HIV meds |
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|''[[Histoplasma capsulatum]]''<br />(CD4 <150 and high risk) |
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|[[Itraconazole]] 200 mg PO once daily |
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|''[[Coccidioides immitis]]''<br />(new IgM or IgG positivity in an endemic area and with CD4 <250) |
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|[[Fluconazole]] 400 mg PO daily |
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"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) |
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== |
==Further Reading== |
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* |
*[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] |
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[[Category:HIV]] |
[[Category:HIV]] |
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Latest revision as of 13:22, 22 October 2020
| 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)
