U.S. Guidelines for the Prevention of Opportunistic Infections
Fall 2000
This article is part of TheBody.com's archive. Because it contains information that may no longer be accurate, this article should only be considered a historical document.
Use if CD4 count is <200 or CD4% is <14% or if patient has a history of oral thrush.
Discontinue when CD4 count is >200 for 3-6 months.
Risk of recurrence is low if CD4 count increases to above 200 (or CD4% increases to above 14%), but there is currently no recommendation to discontinue secondary prophylaxis.
MAC Infection
Biaxin (clarithromycin); Zithromax (azithromycin)
Mycobutin (rifabutin)
Use if CD4 count is <50.
Discontinue when CD4 count is >100 for 3-6 months with sustained HIV suppression.
Risk of recurrence is low if CD4 count increases to above 100, but there is currently no recommendation to discontinue secondary prophylaxis.
CMV Infection
Cytovene (oral ganciclovir)
Not applicable
May be used if CD4 count is <50.
Discontinue when CD4 count is >150 for 3-6 months with sustained HIV suppression, only if non-sight- threatening lesions are present and the patient can undergo regular ophthalmic exams.
Toxoplasmic Encephilitis
Bactrim
Dapsone + Daraprim; Mepron +/- Daraprim
Start prophylaxis when CD4 count is <100.
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Discontinue when CD4 count is >100 for 3-6 months.
After an incidence of toxoplasmic encephalitis, lifelong secondary prophylaxis with Bactrim should be administered.
There is no data to support discontinuing secondary prophylaxis.
Cryptococcosis
Diflucan (fluconazole); Sporanox (itraconazole)
Not applicable
May be used if CD4 count is <50.
After an incidence of cryptococcosis, lifelong secondary prophylaxis with Diflucan should be administered.
Risk of recurrence is low if CD4 count increases to above 100, but there is currently no recommendation to discontinue secondary prophylaxis.
Histoplasmosis
Sporanox
Not applicable
Use if CD4 cell count is <100 and patient lives in area with hyperendemic rate of histoplasmosis.
After an incidence of histoplasmosis, lifelong secondary prophylaxis with Sporanox should be administered.
Risk of recurrence may be low if CD4 count increases to above 100, but there is inadequate data to support discontinuing secondary prophylaxis.
Tuberculosis
Nydrazid (isoniazid); Rifadin (rifampin) or Mycobutin + Pyrazinamide
Not applicable
An individual who has a positive TB skin test but no evidence of active TB should initiate prophylaxis lasting 9 months (Nydrazid) or 2 months (Rifadin/ Pyrazinamide).
Lifelong secondary prophylaxis is not necessary once an individual completes treatment for active TB.
Bacterial Respiratory Infections
Bactrim
Biaxin, Zithromax
Do not use solely to prevent respiratory infections as resistant organisms may develop.
Bactrim may be prescribed for individuals with frequent respiratory infections.
Adapted from the "1999 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus" MMWR 48(RR10);1-59. August 20, 1999.
This article is part of TheBody.com's archive. Because it contains information that may no longer be accurate, this article should only be considered a historical document.
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