Antimicrobial Prophylaxis per CD4 Counts¶
Rachel Pellegrino
| CD4 counts | Opportunistic Infection | Indication for Prophylaxis | Medication | Special Notes |
|---|---|---|---|---|
| <200 cells/mm3 | Pneumocystis Pneumonia (PJP) | CD4 < 200, or CD4 < 14%, may consider discontinuation if CD4 100-200 in setting of viral suppression | TMP-SMX: 1 DS daily (qd), or TMP-SMX: 1SS qd TMP-SMX: 1 DS TIW | If intolerant of TMP-SMX: dapsone*, or inhaled pentamidine, or atovaquone |
| <200 cells/mm3 | Toxoplasma gondii encephalitis | Toxoplasma IgG + and CD4 < 100 | TMP-SMX 1 DS tab daily | Alternative regimens: dapsone + pyrimethamine + leucovorin, or atovaquone (all regimens also effective for PJP) |
| <50 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 | Prevention or Intervention |
|---|---|---|
| Hepatitis A Virus (HAV) | Non-immune with ↑ risk for HAV infection (MSM, IVDU) or chronic liver disease | HAV vaccine series |
| Hepatitis B Virus (HBV) | Pts without chronic HBV or non-immune | HBV vaccine series |
| Human Papilloma virus (HPV) | Age 13-45 | HPV vaccine series |
| Influenza A and B Virus | All pts | Yearly inactivated influenza vaccine |
| Latent Mycobacterium tuberculosis infection (LTBI) | Pts with positive screening test for LTBI with no evidence of active disease. Pts with known exposure |
(INH 300mg + pyridoxine 25-50mg) PO daily for 9 months |
| Streptococcus pneumoniae | All pts | Pts without any previous pneumococcal vaccines: Give PCV15 or PCV20. If PCV15 is used, also give PPSV23 in 1 year. Pts who have already received PPSV23: Give PCV15 or PCV20 one year after most recent PPSV23 vaccine Pts who have already received PCV13: Give PPSV23 |
| Syphilis | All sexually active pts | Screening for syphilis and gonorrhea/chlamydia with treatment if indicated. |
| Herpes zoster (shingles) | Pts > age 50 | Shingrix (recombinant zoster) vaccine series |