_______________________________________________________________________ HIV/AIDS: An Update
CHEMOPROPHYLAXIS TO PREVENT FIRST EPISODE OF OPPORTUNISTIC DISEASE AMONG ADULTS AND ADOLESCENTS INFECTED WITH HIV
Opportunistic Infection
Indication
Preventive Regimen
Preferred a
Alternative
Pneumocystis pneumonia (PCP)
CD4 count 100–200 cells/mcL, if plasma HIV RNA level is above detection limits (AI) CD4 count <100 cells/mcL, regardless of plasma HIV RNA (AII) Note: Patients who are receiving pyrimethamine/ sulfadiazine for treatment or suppression of toxoplasmosis do not require additional PCP prophylaxis (AII).
Trimethoprim- sulfamethoxazole (TMP-SMX) 1 double-strength (DS) daily (AI), or TMP-SMX 1 single-
Regimens for individuals who are seropositive or seronegative for Toxoplasma gondii : TMP-SMX 1 DS three times weekly (BI), or Dapsone 50 mg daily + pyrimethamine 50 mg + leucovorin 25 mg weekly (BI), or Dapsone 200 mg + pyrimethamine 75 mg + leucovorin 25 mg weekly (BI), or Atovaquone 1,500 mg daily (BI) Regimens that should only be used in individuals seronegative for Toxoplasma gondii : Dapsone 100 mg daily or 50 mg twice daily (BI), or Aerosolized pentamidine 300 mg via nebulizer every month (BI), or Intravenous pentamidine 300 mg every 28 days (CIII) TMP-SMX 1 DS three time weekly (BIII), or TMP-SMX 1 SS daily (BIII), or Dapsone 50 mg daily + pyrimethamine 50 mg + leucovorin 25 mg weekly (BI), or Dapsone 200 mg + pyrimethamine 75 mg + leucovorin 25 mg weekly (CI), or Atovaquone 1,500 mg daily (CIII), or Atovaquone 1,500 mg + pyrimethamine 25 mg + leucovorin 10 mg daily (CIII) INH 300 mg + pyridoxine 25–50 mg daily for 6–9 months (AII), or 4R (four months of daily rifampin): Rifampin 600 mg daily for 4 months (BI), or 1HP (one month daily): Rifapentine (weight-based dosing) + INH 300 mg + pyridoxine 25–50 mg) once daily for 4 weeks (BI) Daily weight-based rifapentine dose: <35 kg: 300 mg 35–45 kg; 450 mg >45 kg: 600 mg Note: 1HP is recommended only for patients receiving an efavirenz-based ARV regimen (AI) For persons exposed to drug-resistant TB, select anti-TB drugs after consultation with experts and public health authorities (AIII)
strength (SS) daily (AI) Note: TMP-SMX also
confers protection against toxoplasmosis and some protection against many respiratory bacterial infections
Toxoplasma gondii encephalitis
Toxoplasma immunoglobulin G (IgG)-positive patients with CD4 count <100 cells/mcL (AII) Note: All regimens recommended for primary prophylaxis against toxoplasmosis also are effective as PCP prophylaxis.
TMP-SMX 1 DS daily (AII)
Latent Mycobacterium tuberculosis infection (LTBI)
A positive screening test for LTBI, with no evidence of active TB and no prior treatment for active TB or LTBI (AI), or Close contact with a person with infectious TB (with no evidence of active TB), regardless of screening test results and CD4 count (AII)
3HP (three months of once- weekly isoniazid + rifapentine): Rifapentine (weight-based dosing) + isoniazid (INH) 15 mg/kg (900 mg maximum) + pyridoxine 50 mg weekly for 12 weeks (AI) Weekly weight-based rifapentine dose:
25.1–32 kg: 600 mg 32.1–49.9 kg: 750 mg >50 kg: 900 mg
Note: 3HP is recommended only for virally suppressed persons receiving efavirenz, raltegravir, or once daily dolutegravir-based ARV regimen (AII) OR 3HR (three months of daily isoniazid + rifampin): INH 300 mg + rifampin 600 mg + pyridoxine 25–50 mg daily for 3 months (AI)
Table 1 continues on next page .
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MDCT2026
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