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HIV 101: Treatment of Opportunistic Infections

December 2001

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

The following are recommended as standard of care.1, 2


 Preferred TreatmentAlternative Treatment
Pneumocystis cariniiTrimethoprim (TMP) 15 mg/kg/day + sulfamethoxazole (SMX)75 mg/kg/day PO or IV x 21 days in 3-4 divided doses (typical oral dosage is 2 DS tid)TMP15 mg/kg/day PO + dapsone 100 mg/day PO x 21 days

Pentamidine 4 mg/kg/day IV x 21 days (often reserved for severe cases)

Clindamycin 600 mg IV q8h or 300-450 mg PO q6h + primaquine 30 mg/day base PO x 21 days

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Atovaquone 750 mg suspension PO with meal bid x 21 days

Trimetrexate 45 mg/m² /day + folinic acid 20 mg/m² or IV q6h

Toxoplasma gondiiPyrimethamine 100-200 mg loading dose; then 50-100 mg/day PO + folinic acid 10 mg/day PO + sulfadiazine or trisulfapyrimidime 4-8 g/day PO for at least 6 weeksPyrimethamine + folinic acid (see preferred regimen) + clindamycin 900-1,200** mg IV q6h or 300-450 mg PO q6h for at least 6 weeks

Pyrimethamine and folinic acid (see preferred regimen) plus one of the following: azithromycin 1,200-1,500 mg/day, clarithromycin 1 g bid, or atovaquone 750 mg qid with food

Azithromycin + 900 mg PO x 2 first day, then 1,200 mg/day x 6 weeks, then 600 mg/day (patients <50 kg receive half dose) (salvage therapy)

Mycobacterium avium complex (MAC)Clarithromycin 500 mg PO bid plus Ethambutol (EMB) 15 mg/kg/day POAzithromycin 600 mg/day PO in place of clarithrmycin + Ethambutol (EMB) + Rifabutin (RFB) (same doses)

Combination treatment with amikacin 10-15 mg/kg/day IV or ciprofloxacin 500-700 mg bid

Varicella zosterDermatomal:
Acyclovir 800 mg PO 5x/day at least 7 days (until lesions crust) or famciclovir 500 mg PO tid or valacyclovir 1 g PO tid x >7 days

Disseminated, opthalmic nerve involvement or visceral:
Acyclovir 30-36 mg/kg/day IV at least 7 days

Acyclovir-resistant strains:
Foscarnet 40 mg/kg IV q8h or 60 mg/kg q12h

Dermatomal:
Acyclovir 30 mg/kg/day IV

Foscarnet 40 mg/kg IV q8h or 60 mg/kg IV q12h

Disseminated, opthalmic nerve involvement or visceral:
Foscarnet 40 mg/kg IV q8h or 60 mg/kg IV q12h

Acyclovir-resistant strains:
Cidofovir IV

Topical trifluridine

Cytomegalovirus retinitis (CMV)**Intraocular ganciclovir implant (Vitrasert) q6 months + oral valganciclovir 900 mg/day

Foscarnet 60 mg/kg IV q8h or 90 mg/kg IV q12h x 14 to 21 days

Ganciclovir 5 mg/kg IV bid x 14 to 21 days

Valganciclovir 900 mg PO bid x 21 days, then 900 mg/day

Cidofovir 5 mg/kg IV q week x2, then 5 mg/kg q 2 weeks + probenecid, 2 g PO 3 hours before each dose, 1 g PO at 2 and 8 hours post dose (total of 4 g)

Alternating or combining foscarnet and ganciclovir

Intraocular injections of foscarnet 1.2-2.4 mg in 0.1 mL (N Engl J Med 1994;330:868) or ganciclovir 2,000 µg in 0.05-0.1 mL (Br J Ophthal 1996;80:214)

Fomivirsen, 330 mg by intravitreal injection day 1 and 15, then monthly

Herpes SimplexMild:
Acyclovir 400 mg PO tid or famciclovir 250 mg PO tid or valacyclovir 1.0 g PO bid; all given for 7 to 10 days

Severe or Refractory:
1. Acyclovir up to 800 mg PO 5x/day or 15-30 mg/kg/day IV at least 7 days

2. Valacyclovir 1 g PO bid-tid

Severe or Refractory:
Foscarnet 40 mg/kg IV q8h or 60 mg/kg q12h x 3 weeks

Topical trifluridine as 1% ophthalmic solution q8h

Alternative topical agents:
Cidofovir 3% and foscarnet 1% cream

Cidofovir 5 mg/kg q 2 weeks (limited experience)

** Initital Treatment Recommendations of the IAS-USA (Arch Intern Med 1998;158:957). For information on maintenance and other forms of therapy, consult reference below.


* Nothing to disclose.


References

  1. Bartlett J.G. and Gallant J.E. 2001-2002 Medical Management of HIV Infection, Chapter 5. Johns Hopkins University, Baltimore, MD. 2001.

  2. 2001 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus.


Back to the HEPP News December 2001 contents page.

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!



  
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This article was provided by Brown Medical School. It is a part of the publication HEPP News.
 
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