You are here

Opportunistic Infection Prophylaxis

 

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[1]

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)