LAST UPDATED on 5-7-2017
Prophylaxis should be considered to prevent certain opportunistic infections. The following table is addapted from the DHHS Guidelines for the Prevention and Treatment of Opportunistic Infections[bib]196 [/bib]
CD4 Count | Opportunistic Infection | Recommendation | Alternative |
<250 | Coccidiomycosis (ONLY IF new positive IgM or IgG in patients who live in a disease-endemic area with CD4 <250) |
Fluconazole 400 mg PO daily (BIII) |
|
<200 | Pneumocystis pneumonia (PCP) |
• TMP-SMX 1 double strength (DS) PO daily (AI), or • TMP-SMX 1 single strength (SS) daily (AI) |
• TMP-SMX 1 DS PO three times weekly (BI), or • Dapsone 100 mg PO daily or 50 mg PO BID (BI), or • Dapsone 50 mg PO daily + (pyrimethamine 50 mg + leucovorin 25 mg) PO weekly (BI), or • (Dapsone 200 mg + pyrimethamine 75 mg + leucovorin 25 mg) PO weekly (BI); or • Aerosolized pentamidine 300 mg via Respigard II™ nebulizer every month (BI), or • Atovaquone 1500 mg PO daily (BI), or • (Atovaquone 1500 mg + pyrimethamine 25 mg + leucovorin 10 mg) PO daily (CIII) *Check for G6PD deficiency before administration of daspone |
<150 | Histoplasma capsulatum (ONLY if at high risk because of living in a hyperendemic region with rates of histoplasmosis >10 cases/100 patient-years) |
Itraconazole 200 mg PO daily (BI) |
|
<100 | Toxoplasma gondii (for patients that are toxo IgG positive) |
TMP-SMX 1 DS PO daily (AII) |
• TMP-SMX 1 DS PO three times weekly (BIII), or • TMP-SMX 1 SS PO daily (BIII), or • Dapsone 50 mg PO daily + (pyrimethamine 50 mg + leucovorin 25 mg) PO weekly (BI), or • (Dapsone 200 mg + pyrimethamine 75 mg + leucovorin 25 mg) PO weekly (BI); or • Atovaquone 1500 mg PO daily (CIII); or • (Atovaquone 1500 mg + pyrimethamine 25 mg + leucovorin 10 mg) PO daily (CIII) *Check for G6PD deficiency before administration of daspone |
Penicilliosis (ONLY if CD4<100 AND live or stay for long periods in rural areas of northern Thailand, Vietnam, or Southen China) |
Itraconazole 200 mg once daily (BI) |
Fluconazole 400 mg PO once weekly (BII) |
|
<50 | Mycobacterium avium (MAC): only after ruling out active disseminated MAC disease based on clinical assessment |
• Azithromycin 1200 mg PO once weekly (AI), or • Clarithromycin 500 mg PO BID (AI), or • Azithromycin 600 mg PO twice weekly (BIII) |
Rifabutin (dose adjusted based on concomitant ART) (BI); rule out active TB before starting rifabutin |
Miscellaneous at all CD4 counts | Streptococcus pneumoniae |
If never received vaccinations: 1)PCV13 0.5 mL IM x 1 (AI)-->followed by: a)if CD4>=200: PPV23 0.5 mL IM or SQ at least 8 weeks after the PCV13 vaccine (AII). b)If CD4<200 PPV23 can be offered at least 8 weeks after receiving PCV13 (CIII) or can wait until CD4 count increased to ≥200 cells/µL (BIII). If previously received PPV23: One dose of PCV13 should be given at least 1 year after the last receipt of PPV23 (AII). |
REVACCINATION: 1)• If ≥5 years since the first PPV23 dose: PPV23 0.5 mL IM or SQ x 1 (BIII)
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