Opportunistic infections in HIV: Difference between revisions

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{| class="wikitable"
  
{| 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 simplex]]<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
 +
|''[[Pneumocystis jirovecii]]'' pneumonia
−
| Start PJP prophylaxis (Septra SS or DS)
 +
|Start [[PJP]] prophylaxis ([[TMP-SMX]] SS or DS)
 
|-
  
|-
−
| &lt;150
 +
|&lt;150
−
| [[Dimorphic fungi]]
 +
|[[Dimorphic fungi]]
−
| Start histoplasmosis prophylaxis if high risk (occupation or hyperendemic) (itra)
 +
|Start [[histoplasmosis]] prophylaxis if high risk (occupation or hyperendemic) ([[itraconazole]])
 
|-
  
|-
−
| &lt;100
 +
|&lt;100
−
| [[Toxoplasmosis]]<br/>[[Cryptococcus]]
 +
|[[Toxoplasmosis]]<br />[[Cryptococcus]]
−
| Start toxo prophylaxis if IgG positive (Septra DS)
 +
|Start [[toxoplasmosis]] prophylaxis if IgG positive ([[TMP-SMX]] DS)
 
|-
  
|-
−
| &lt;50
 +
|&lt;50
−
| [[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]]
−
| Start MAC prophylaxis (azithromycin)
 +
|Start [[Mycobacterium avium complex|MAC]] prophylaxis ([[azithromycin]])
 
|}
  
|}
   
−
== Prophylaxis regimens ==
 +
==Prophylaxis regimens==
 
{| class="wikitable"
  
{| class="wikitable"
−
! Infection !! Preferred !! Alternative
 +
!Infection!!Preferred!!Alternative
 
|-
  
|-
−
| rowspan=4 | ''[[Pneumocystis jirovecii]]''<br/>(CD4 &lt;200 or &lt;14%)
 +
| rowspan="4" |''[[Pneumocystis jirovecii]]''<br />(CD4 &lt;200 or &lt;14%)
−
| rowspan=4 | [[TMP-SMX]] 1 DS or SS PO daily
 +
| rowspan="4" |[[TMP-SMX]] 1 DS or SS PO daily
−
| [[TMP-SMX]] 1 DS PO three times weekly
 +
|[[TMP-SMX]] 1 DS PO three times weekly
 
|-
  
|-
−
| [[Dapsone]] 100 mg PO daily or 50 mg PO BID
 +
|[[Dapsone]] 100 mg PO daily or 50 mg PO BID
 
|-
  
|-
−
| [[Pentamidine]] nebs 300 mg every month
 +
|[[Pentamidine]] nebs 300 mg every month
 
|-
  
|-
−
| [[Atovaquone]] 1500 mg PO daily
 +
|[[Atovaquone]] 1500 mg PO daily
 
|-
  
|-
−
| rowspan=4 | ''[[Toxoplasma gondii]]''<br/>(CD4 &lt;100 and IgG positive)
 +
| rowspan="4" |''[[Toxoplasma gondii]]''<br />(CD4 &lt;100 and IgG positive)
−
| rowspan=4 | [[TMP-SMX]] 1 DS PO daily
 +
| rowspan="4" |[[TMP-SMX]] 1 DS PO daily
−
| [[TMP-SMX]] 1 DS PO three times weekly
 +
|[[TMP-SMX]] 1 DS PO three times weekly
 
|-
  
|-
−
| [[TMP-SMX]] 1 SS PO daily
 +
|[[TMP-SMX]] 1 SS PO daily
 
|-
  
|-
−
| [[Dapsone]] 50 mg PO daily + pyrimethamine/leucovorin PO weekly
 +
|[[Dapsone]] 50 mg PO daily + pyrimethamine/leucovorin PO weekly
 
|-
  
|-
−
| [[Atovaquone]] 1500 mg PO daily
 +
|[[Atovaquone]] 1500 mg PO daily
 
|-
  
|-
−
| rowspan=3 | ''[[Mycobacterium avium complex]]''<br/>(CD4 &lt;50 and ''not'' on therapy)
 +
| rowspan="3" |''[[Mycobacterium avium complex]]''<br />(CD4 &lt;50 and ''not'' on HIV therapy)
−
| rowspan=3 | [[Azithromycin]] 1200 mg PO once weekly
 +
| rowspan="3" |[[Azithromycin]] 1200 mg PO once weekly
−
| [[Clarithromycin]] 500 mg PO BID
 +
|[[Clarithromycin]] 500 mg PO BID
 
|-
  
|-
−
| [[Azithromycin]] 600 mg PO twice weekly
 +
|[[Azithromycin]] 600 mg PO twice weekly
 
|-
  
|-
−
| [[Rifabutin]], dose-adjusted to HIV meds
 +
|[[Rifabutin]], dose-adjusted to HIV meds
 
|-
  
|-
−
| ''[[Histoplasma capsulatum]]''<br/>(CD4 <150 and high risk)
 +
|''[[Histoplasma capsulatum]]''<br />(CD4 <150 and high risk)
−
| [[Itraconazole]] 200 mg PO once daily
 +
|[[Itraconazole]] 200 mg PO once daily
−
|
+
|
 
|-
  
|-
−
| ''[[Coccidioides immitis]]''<br/>(new IgM or IgG positivity in an endemic area and with CD4 &lt;250)
 +
|''[[Coccidioides immitis]]''<br />(new IgM or IgG positivity in an endemic area and with CD4 &lt;250)
−
| [[Fluconazole]] 400 mg PO daily
 +
|[[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)
 +
* "High risk" for ''Histoplasma'' includes occupational exposure or residence in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years)
   
−
== 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]]
  
[[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)

Further Reading

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