Opportunistic infections in HIV: Difference between revisions
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{| class="wikitable" |
{| class="wikitable" |
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− | ! |
+ | !CD4 |
− | ! |
+ | !Infections |
− | ! |
+ | !Action |
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− | | |
+ | |Any |
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+ | |[[Tuberculosis]] |
− | | |
+ | |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 |
− | | |
+ | |Start [[PJP]] prophylaxis ([[TMP-SMX]] SS or DS) |
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− | | |
+ | |<150 |
+ | |[[Dimorphic fungi]] |
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⚫ | |||
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+ | |Start [[histoplasmosis]] prophylaxis if high risk (occupation or hyperendemic) ([[itraconazole]]) |
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+ | |<100 |
⚫ | |||
⚫ | |||
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+ | |Start [[toxoplasmosis]] prophylaxis if IgG positive ([[TMP-SMX]] DS) |
+ | |- |
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+ | |<50 |
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− | == |
+ | ==Prophylaxis regimens== |
+ | {| class="wikitable" |
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+ | !Infection!!Preferred!!Alternative |
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+ | |- |
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+ | |- |
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+ | |- |
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+ | |- |
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+ | |- |
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⚫ | |||
+ | |- |
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+ | |- |
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+ | |- |
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+ | |- |
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+ | | rowspan="3" |''[[Mycobacterium avium complex]]''<br />(CD4 <50 and ''not'' on HIV therapy) |
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⚫ | |||
+ | |- |
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+ | |- |
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+ | |- |
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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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+ | | |
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+ | |- |
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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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+ | | |
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+ | |} |
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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) |
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− | ** Alternate |
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− | ** Alternate |
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− | ** Alternate |
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− | == |
+ | ==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] |
[[Category:HIV]] |
[[Category:HIV]] |
Latest revision as of 09:22, 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)