U.S. Guidelines for the Prevention of Opportunistic Infections

Condition

Preferred MedicationsAlternate MedicationsPrimary ProphylaxisSecondary Prophylaxis
PCPBactrim (TMP-SMZ)Dapsone; Dapsone + Daraprim (pyrimethamine) + Leucovorin; NebuPent (aerosolized pentamidine); Mepron (atovaquone)Use if CD4 count is <200 or CD4% is <14% or if patient has a history of oral thrush.

Discontinue when CD4 count is >200 for 3-6 months.

Risk of recurrence is low if CD4 count increases to above 200 (or CD4% increases to above 14%), but there is currently no recommendation to discontinue secondary prophylaxis.
MAC InfectionBiaxin (clarithromycin); Zithromax (azithromycin)Mycobutin (rifabutin)Use if CD4 count is <50.

Discontinue when CD4 count is >100 for 3-6 months with sustained HIV suppression.

Risk of recurrence is low if CD4 count increases to above 100, but there is currently no recommendation to discontinue secondary prophylaxis.
CMV InfectionCytovene (oral ganciclovir)Not applicableMay be used if CD4 count is <50.Discontinue when CD4 count is >150 for 3-6 months with sustained HIV suppression, only if non-sight- threatening lesions are present and the patient can undergo regular ophthalmic exams.
Toxoplasmic EncephilitisBactrimDapsone + Daraprim; Mepron +/- DaraprimStart prophylaxis when CD4 count is <100.

Discontinue when CD4 count is >100 for 3-6 months.

After an incidence of toxoplasmic encephalitis, lifelong secondary prophylaxis with Bactrim should be administered.

There is no data to support discontinuing secondary prophylaxis.

CryptococcosisDiflucan (fluconazole); Sporanox (itraconazole)Not applicableMay be used if CD4 count is <50.After an incidence of cryptococcosis, lifelong secondary prophylaxis with Diflucan should be administered.

Risk of recurrence is low if CD4 count increases to above 100, but there is currently no recommendation to discontinue secondary prophylaxis.

HistoplasmosisSporanoxNot applicableUse if CD4 cell count is <100 and patient lives in area with hyperendemic rate of histoplasmosis.After an incidence of histoplasmosis, lifelong secondary prophylaxis with Sporanox should be administered.

Risk of recurrence may be low if CD4 count increases to above 100, but there is inadequate data to support discontinuing secondary prophylaxis.

TuberculosisNydrazid (isoniazid); Rifadin (rifampin) or Mycobutin + PyrazinamideNot applicableAn individual who has a positive TB skin test but no evidence of active TB should initiate prophylaxis lasting 9 months (Nydrazid) or 2 months (Rifadin/ Pyrazinamide).Lifelong secondary prophylaxis is not necessary once an individual completes treatment for active TB.
Bacterial Respiratory InfectionsBactrimBiaxin, ZithromaxDo not use solely to prevent respiratory infections as resistant organisms may develop.Bactrim may be prescribed for individuals with frequent respiratory infections.
Adapted from the "1999 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus" MMWR 48(RR10);1-59. August 20, 1999.