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Opportunistic Infection (OI) Prevention |
| 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 |
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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 6.25.2006
