Primary Care of the Newly Diagnosed HIV-Infected Patient in Developed Countries

  • Author: Mary W. Montgomery, MD (More Info)
  • Editors in Chief: Daniel R. Kuritzkes, MD; Joseph J. Eron, Jr., MD
  • Last Reviewed: 8/20/18 (What's New)

Supporting Assets

Table

Table. Prophylaxis for Opportunistic Infections[CDC OI; Aberg 2014]

Pathogen

Indication

Agents

Pneumocystis jiroveci

CD4+ cell count < 200 cells/mm3 or a history of oropharyngeal candidiasis*

Alternatives

Toxoplasma gondii

CD4+ cell count < 100 cells/mm3 and positive anti-Toxoplasma immunoglobin G

Alternative

Mycobacterium avium complex

CD4+ cell count < 50 cells/mm3†

Alternatives

Mycobacterium tuberculosis

Positive screening test for latent TB or interferon-γ release assay with no evidence of active TB and no history of TB treatment, or exposure to active case; consult local experts regarding treatment selection in suspected drug-resistant cases

Alternatives

Fungi (Candida species, Cryptococcus neoformans)

Primary prophylaxis not indicated; secondary prophylaxis (maintenance therapy) indicated after initial treatment for cryptococcosis or for frequent or severe recurrent candidiasis

Cytomegalovirus

Primary prophylaxis not indicated; maintenance therapy indicated after initial treatment for cytomegalovirus retinitis until immune recovery on ART is achieved; choice of regimen should be made in consultation with an ophthalmologist

Alternatives

Herpes simplex or varicella zoster

Primary prophylaxis not indicated; consider secondary prophylaxis for patients with severe recurrences; varicella vaccination recommended in patients with CD4+ cell count ≥ 200 cells/mm3 without documentation of vaccination; consider zoster vaccine live vaccination for patients 60 years of age or older with CD4+ cell count ≥ 200 cells/mm3 and with evidence of varicella immunity

TB, tuberculosis.
*Patients with CD4+ cell count of 100-200 cells/mm3 and suppressed HIV-1 RNA receiving ART are at low risk of Pneumocystis jiroveci infection,[HIVERiE 2010; D’Egidio 2007] suggesting that prophylaxis may be safely discontinued. Although data are insufficient to formally recommend this strategy, some experts consider it reasonable.[IAS-USA ART]
Primary prophylaxis for Mycobacterium avium complex is no longer recommended by IAS-USA panel in patients receiving or initiating virologically suppressive ART.[IAS-USA ART]

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