Antimicrobial Prophylaxis per CD4 Counts¶
Rachel Pellegrino
| 0 | 1 | 2 | 3 | 4 |
|---|---|---|---|---|
| CD4 counts | Opportunistic Infection | Indication for Prophylaxis | Medication | Special Notes |
| <200 cells/mm3 | Pneumocystis Pneumonia (PJP) | CD4 < 200, or CD4 < 14%, or CD4 200-250 w/ delayed init. ART & poor f/u | TMP-SMX: 1 DS daily (qd), or TMP-SMX: 1SS qd TMP-SMX: 1 DS TIW | If intolerant of TMP-SMX: dapsone*, or pentamidine, or atovaquone |
| <200 cells/mm3 | Toxoplasma gondii encephalitis | Toxoplasma IgG + and CD4 < 100 | TMP-SMX 1 DS tab daily | Alternative regimens: Dapsone, or Atovaquone (all regimens effect. for PJP ) |
| <200 cells/mm3 | Mycobacterium avium- intracellulare (MAC, MAI) | Only if not on fully suppressive ART and active disseminated MAC is ruled out | - Azithromycin 1200 mg weekly, or -Clarithromycin 500 mg BID, or - Rifabutin 300 mg daily | NOT indicated for those initiating ART |
| Infection | Screening Indication | Intervention |
|---|---|---|
| Hepatitis A Virus (HAV) | Non-immune w/ ↑ risk for HAV infection (MSM, IVDU) or chronic liver disease | HAV vaccine |
| Hepatitis B Virus (HBV) | Pts w/o chronic HBV or non-immune | HBV vaccine. Ideally admin. before CD4 < 350 |
| Human Papilloma virus (HPV) | Age 13-45 | HPV vaccine series |
| Influenza A and B Virus | All patients | Yearly inactivated influenza vaccine |
| Latent Mycobacterium tuberculosis infection (LTBI) | -Pts with positive screening test for LTBI w/ no evidence of active disease. -Pts w/ known exposure | (INH 300mg + pyridoxine 25-50mg) PO daily for 9 months |
| Streptococcus pneumoniae | All patients | PCV13 and PPV23 (order and timing depends on previous vaccination history and CD4) |
| Syphilis | All pts exposed to sex partner with syphilis diagnosis | Screening for syphilis and gonorrhea/chlamydia with treatment if indicated. |
| Varicella Zoster Virus (VZV) | Pre-exposure: CD4 >200, no previous vaccine.Shingrix (recombinant vaccine) is not live virus, only Zostavax (live virus) is contraindicated for CD4 <200). Post-exposure: Close contact, particularly if CD4 <200 | Pre-exposure: Consider vaccination Post-exposure: Varicella-zoster immune globulin |
Last update:
2022-10-15 17:31:10