Appendix G: Treatment and Prophylaxis for Common Infections in HIV-Postive Patients
|
Disease Likely CD4 count at occurrence |
Preferred treatment regimen(s) | Preferred prophylactic regimen(s) |
|---|---|---|
|
Candidiasis, esophageal CD4 <200 cells/mm3 |
Fluconazole 400 mg/day orally for 14-21 days | No prophylaxis |
|
Candidiasis, oropharyngeal CD4 <200 cells/mm3 |
Fluconazole 200 mg/day orally for 10-14 days | No prophylaxis |
| Herpes simplex, genital (first episode) | Acyclovir 400 mg orally 5x/day for 10 days | No prophylaxis |
| Herpes, uncomplicated varicella-zoster | Acyclovir 800 mg orally 5x/day for 10 days | No prophylaxis |
| Herpes, disseminated (or complicated) varicella-zoster | Acyclovir 10 mg/kg IV over 1 hour 3x/day for 7 days; max dose 20 mg/kg 3x/day | No prophylaxis |
| Malaria, chloroquine-sensitive |
Chloroquine 1 g (600 mg base) followed by 500 mg in 6 hours then 500 mg/day for 2 days Alternative: quinine 640 mg 3x/day orally or IV + doxycycline 100 mg 2x/day orally for 7 days |
Consider prophylaxis based on local resistance patterns for pregnant women in endemic areas |
| Malaria, chloroquine-resistant | Quinine 650 mg 3x/day orally or IV + doxycycline 100 mg 2x/day orally for 7 days | Consider prophylaxis based on local resistance patterns for pregnant women in endemic areas |
|
Meningitis, cryptococcal CD4 <100 cells/mm3 |
Amphotericin B 1 mg/kg/day IV + flucytosine 25 mg/kg orally if available for 14 days, followed by fluconazole 400 mg/day orally or IV for 8-10 weeks | Secondary prophylaxis after treatment: fluconazole 200 mg/day orally |
|
Mycobacterium avium complex CD4 <50 cells/mm3 |
Clarithromycin 500 mg orally 2x/day + E 15 mg/kg/day + RFB 300 mg/day Alternative: azithromycin 600 mg/day orally + E 15 mg/kg/ day + RFB 300 mg/day |
Primary prophylaxis if CD4 <50 cells/mm3: azithromycin 1200 mg/ week orally Alternative: clarithromycin 500 mg 2x/day orally |
|
Pneumocystis carinii pneumonia CD4 <200 cells/mm3 |
TMP/SMX 2 DS tablets 3x/day for 21 days Alternatives: atovaquone 750 mg 2x/day orally for 21 days or clindamycin 300-450 mg 4x/ day orally + primaquine 30 mg/ day orally for 21 days |
Primary and secondary lifelong prophylaxis: TMP/SMX 1 DS tablet/ day or 3x/week Alternatives: dapsone 100 mg/day orally or atovaquone 750 mg/day orally |
| Syphilis, early or less than one year |
Single-dose benzathine benzylpenicillin 2.4 MU IM Alternative: doxycyline 100 mg 2x/day orally for 15 days |
No prophylaxis |
| Syphilis, latent or more than one year |
Benzathine benzylpenicillin 2.4 MU/week IM for 3 weeks Alternative: doxycyline 100 mg 2x/day orally for 30 days |
No prophylaxis |
| Syphilis, neurosyphilis |
Benzathine benzylpenicillin 3-4 MU IV 6x/day for 10-14 days Alternative: procaine-penicillin G 2.4 MU/day IM + probenecid 0.5 g orally 4x/day for 10 days |
No prophylaxis |
|
Toxoplasmosis CD4 <100 cells/mm3 |
Preferred: pyrimethamine 100 mg orally first day, then 50-100 mg/day + sulfadiazine 0.5-2 g 4x/day + folinic acid 10 mg/day for at least six weeks, then lifelong prophylaxis Alternatives: TMP 10 mg/kg/ day divided 2x/day (not first-line therapy) for at least 6 weeks, followed by suppression regimen; or pyrimethamine 200 mg loading dose orally followed by 75 mg/day + sulfadiazine 6-8 g/day orally in 4 divided doses |
Primary prophylaxis if CD4 <200 cells/mm3: TMP/SMX 1 DS tablet/day Secondary prophylaxis: pyrimethamine 25-50 mg/day + sulfadiazine 0.5-1 g 4x/day + folinic acid 10 mg/day |
| Tuberculosis | See Tables 2.1 and 2.2 | Primary prophylaxis if PPD >5 mm: H 300 mg/ day + pyridoxine 50 mg/ day for 9 months |
| Typhoid fever, less severe cases |
Ciprofloxacin 500 mg orally 2x/day for 10 days Alternatives: TMP/SMX 1 DS tablet 2x/day for 10 days or cefixime 10-15 mg/kg orally 2x/day for 10 days |
No prophylaxis |
| Typhoid fever, severe cases | Ceftriaxone 50 mg/kg/day IV for 14 days (max dose 2 g/day) | No prophylaxis |
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