Opportunistic infections in HIV: Difference between revisions

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)

@@ Line 1: / Line 1: @@
 {| 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]]
 |-
-| &lt; 500
+|&lt;500
-| Kaposi sarcoma (HHV-8)<br/>Herpes simples<br/>Varicella zoster
+|[[Kaposi sarcoma]] (HHV-8)<br />[[Herpes simplex]]<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
-| Start PJP prophylaxis (Septra SS or DS)
+|Start [[PJP]] prophylaxis ([[TMP-SMX]] SS or DS)
 |-
-| &lt; 100
+|&lt;150
+|[[Dimorphic fungi]]
-| Toxoplasmosis<br/>Cryptococcus
-| Start toxo prophylaxis if IgG positive (Septra DS)
+|Start [[histoplasmosis]] prophylaxis if high risk (occupation or hyperendemic) ([[itraconazole]])
 |-
-| &lt; 50
+|&lt;100
+|[[Toxoplasmosis]]<br />[[Cryptococcus]]
-| Mycobacterium avium complex (MAC)<br/>Cytomegalovirus (CMV), including retinitis<br/>Progressive multifocal leukoencephalopathy (PML) from JC virus
-| Start MAC prophylaxis (azithromycin)
+|Start [[toxoplasmosis]] prophylaxis if IgG positive ([[TMP-SMX]] DS)
+|-
+|&lt;50
+|[[Mycobacterium avium complex]]<br />[[Cytomegalovirus]], including retinitis<br />Progressive multifocal leukoencephalopathy (PML) from [[JC virus]]
+|Start [[Mycobacterium avium complex|MAC]] prophylaxis ([[azithromycin]])
 |}
-== Prophylaxis regimens ==
+==Prophylaxis regimens==
+{| class="wikitable"
+!Infection!!Preferred!!Alternative
+|-
+| rowspan="4" |''[[Pneumocystis jirovecii]]''<br />(CD4 &lt;200 or &lt;14%)
+| 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]]''<br />(CD4 &lt;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]]''<br />(CD4 &lt;50 and ''not'' on HIV therapy)
+| 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]]''<br />(CD4 <150 and high risk)
+|[[Itraconazole]] 200 mg PO once daily
+|
+|-
+|''[[Coccidioides immitis]]''<br />(new IgM or IgG positivity in an endemic area and with CD4 &lt;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)
-* ''Pneumocystis jirovecii'' (CD4 &lt;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 &lt;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 &lt;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 ==
+==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]]