Antimicrobial Prophylaxis per CD4 Counts

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 TMPSMX: 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 + pyramethamine + leucovorin, or atovaquone (all regimens also effective for PJP )
<50 cells/mm3	Mycobacterium aviumintracellulare (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	HAV vaccine series
Human Papilloma virus (HPV)	Age 13-45	HAV 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