Complications of HIV Disease or TreatmentProphylaxis Against Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus
Section snippets
Preventing Exposure
Recommendations by some authorities to avoid having HIV-infected patients who are at high risk for P carinii pneumonia (PCP) share a room with a patient who has PCP have not been supported by recent research. Person-to-person transmission of PCP may occur occasionally, but it does not constitute the major route of human transmission (CIII).
Indications: Primary and Secondary Prophylaxis
Prophylaxis is indicated for HIV-infected individuals with a CD4 count less than 200 cells/ mm3 (AII) or a history of oropharyngeal candidiasis (AII). Consider
Indications
All patients with HIV disease with a CD4 count of 200 cells/mm3 or greater should receive a single dose of 23-valent polysaccharide pneumococcal vaccine 0.5 mL intramuscularly (IM) if they have not received this vaccine during the previous 5 years (BIII).
Immunization can be considered for patients with CD4 counts of less than 200/mm3, and then they should be revaccinated when CD4 counts increase to greater than 200 cells/mm3 in response to HAART (CIII).
The duration of the protective effect of
Preventing Exposure
Persons infected with HIV cannot avoid exposure to C neoformans, which is a common environmental fungus. No evidence exists that exposure to pigeon droppings is associated with an increased risk for developing cryptococcosis.
Indications
Routine testing of asymptomatic persons for the cryptococcal antigen is not recommended because of low probability that the results will affect clinical decisions (DIII). Fluconazole and itraconazole can decrease the incidence of infection in patients with advanced HIV
Management of Prophylaxis for Opportunistic Infections in Pregnancy
Recommendations for prophylaxis to prevent opportunistic infections in adults and adolescents should be followed with slight modifications during pregnancy (Table 2).1., 6. Prophylactic regimens to prevent PCP, MTB, MAC, and toxoplasmosis are similar to those for nonpregnant individuals. Primary prophylaxis against cytomegalovirus, oral candidiasis, and invasive fungal infections is not recommended routinely for pregnant or nonpregnant individuals because of drug toxicity, side effects, and
References (6)
Guidelines for preventing opportunistic infections among HIV-infected persons–2002
MMWR Recomm Rep
Recommendations of the U. S. Public Health Service and the Infectious Diseases Society of America
(2002)Report of the NIH Panel to define principles of therapy of HIV infection and guidelines for use of antiretroviral agents in HIV-infected adults and adolescents
MMWR Recomm Rep
(1998)Updated guidelines for the use of rifabutin or rifampin for the treatment and prevention of tuberculosis among HIV-infected patients taking protease inhibitors or nonnucleoside reverse transcriptase inhibitors
MMWR Morb Mortal Wkly Rep
(2000)