Antimicrobial Prophylaxis per CD4 Counts
Samantha Hobbs
CD4 |
Opportunistic Infection |
Prophylaxis |
D/C Criteria |
|---|---|---|---|
| All | Flu, HAV, HBV, HPV, VZV, S. pneumo, TB, STI | Vaccines* (per age, prior vax hx) Screening for LTBI, syphilis, GC/CT |
N/A |
| <200 | PJP | Bactrim, dapsone**, inhaled pentamidine, or atovaquone | CD4 >200 x3mo OR 100-200+ undetectable VL |
| <100 | Toxoplasma (if IgG+) | Bactrim, atovaquone, dapsone + pyrimethamine + leucovorin | CD4 >200 x3mo |
| <50 | MAC (Not if on effective ART) | Azithro, clarithro, OR Rifabutin*** |
CD4>100 x 3mo OR initiating ART |
*Visit https://www.hiv.uw.edu/go/basic-primary-care/immunizations/core-concept/all for full and up to date vaccination recommendations
**Dapsone: check G6PD first
***Rifabutin: must rule out active TB first. Interacts with many ART options.
- NOTE: Primary prophylaxis is not indicated for Coccidioidomycosis (CD4<250), Cryptococcal meningitis (CD4<100), candida esophagitis (CD4<100), or CMV (CD4<50). Some guidelines recommend Histo ppx in endemic areas for CD4 <150; however, we do not routinely do this as there is no proven mortality benefit
- Sources: National HIV Curriculum https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinicalguidelines- adult-and-adolescent-opportunistic-infections/immunizations