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Opportunistic Infection (OI) Prevention
For Persons with Advanced HIV


 

Quick Links to OI Prevention
Pneumocystis carinii pneumonia (PCP)
Disseminated Mycobacterium avium complex (DMAC)
Toxoplasma gondii (toxoplasmosis)
Cytomegalovirus (CMV)
Deep-seated fungal infection

 

 

Pneumocystis carinii pneumonia (PCP) prevention 
Indication: CD4 <200 or 200-300 with HIV viral load > 100,000/ml, symptomatic HIV, AIDS, unexplained fever, oral candidiasis
Drug Dosing Side effects Comments
sulfamethoxazole / trimethoprim 1 double strength (DS) tablet (400/80) once a day or three times per week or every other day Bone marrow suppression, hyperkalemia, renal failure, hepatitis, rash Drug of choice; desensitization is unproven, possibly ineffective, and possibly hazardous, but may attempted when necessary; also effective for Toxoplasma gondii disease prevention
dapsone 100 mg per day Bone marrow suppression, rash, stomatitis, peripheral neuropathy Hypersensitivity is cross-reactive with sulfamethoxazole / trimethoprim approx 20-30%; contraindicated with G6PD deficiency
atovaquone 1500 mg per day in one or two doses Rash, diarrhea, headache Expensive and unpleasant bright orange suspension
aerosolized pentamidine 300 mg per month via respiratory therapy over 20-30 minutes in a room with respiratory isolation controls Bad taste in mouth, cough; rare systemic toxicity Expensive and labor intensive with no prevention of rare systemic disease; premedicate with beta-agonist inhaler 30 mins before treatment in smokers or in the setting of lower respiratory tract disease
sulfadiazine 4-8 grams per day Nephrotoxicity due to crystallization in the urinary tract, rash, bone marrow suppression This regimen is used to treat toxoplasmosis and is effective for PCP prevention also

 

 

 

Toxoplasma gondii disease prevention 
Indication: CD4 < 50 - 100
Drug Dosing Side effects Comments
sulfamethoxazole / trimethoprim 1 double strength (DS) tablet (400/80) once a day or three times per week or every other day Bone marrow suppression, hyperkalemia, renal failure, hepatitis, rash Also effective against Pneumocystis carinii pneumonia
dapsone + pyrimethamine dapsone 100 mg per day + pyrimethamine 50 mg per week + folinic acid 25 mg per week Bone marrow suppression, rash, stomatitis, peripheral neuropathy Hypersensitivity is cross-reactive with sulfamethoxazole / trimethoprim approximately 20-30%; contraindicated with G6PD deficiency

 

 

 

Mycobacterium avium complex (MAC) disease prevention 
Indication: CD4 < 50-100
Drug Dosing Side effects Comments
azithromycin 2x600 mg po once a week or 250 mg once a day Diarrhea (once a week regimen), hepatitis, hearing loss (rare) Once a day regimen is expensive
clarithromycin 500 mg bid Hepatitis, bad taste in mouth, rash, GI upset, abdominal pain Multiple drug interactions, expensive
rifabutin 2x150 mg once a day; reduce dose to 150 mg per day when used with protease inhibitors Hepatitis, rash, uveitis (rare), pink discoloration of body fluids Multiple drug interactions

 

 

 

Cytomegalovirus (CMV) disease prevention 
Indication: CD4 < 100 in selected patients
Drug Dosing Side effects Comments
ganciclovir 500 mg po tid with food Bone marrow suppression, rare renal failure Recommend retinal exams for patients with CD4 < 100 every 3 months; high cost-to-benefit analysis; expensive
valganciclovir 450 mg bid??? Same as above Prodrug of ganciclovir; same as above; untested but probably effective

 

 

 

Deep-seated fungal infection prevention 
Indication: CD4 < 50-100 in selected patients
Drug Dosing Side effects Comments
fluconazole 100 mg daily or every other day by mouth Hepatitis, rash, GI discomfort, nausea and vomiting High cost-to-benefit analysis; expensive; multiple drug interactions
Other imidazole antifungal agents
(except clotrimazole and ketoconazole)
Dosing unclear Same as above Unproven but probably effective; expensive; multiple drug interactions

 

 

 

Next page Click HERE for Recommendations for Laboratory Evaluations of Persons With HIV Infection

 

Updated 1/17/2013