HIV/AIDS: An Update ________________________________________________________________________
CHEMOPROPHYLAXIS TO PREVENT FIRST EPISODE OF OPPORTUNISTIC DISEASE AMONG ADULTS AND ADOLESCENTS INFECTED WITH HIV (Continued)
Opportunistic Infection
Indication
Preventive Regimen
Preferred a
Alternative
Disseminated Mycobacterium avium complex (MAC) disease
CD4 count <50 cells/mcL and not receiving ART or remains viremic on ART or has no options for a fully suppressive ART regimen (AI) Not recommended for those who immediately initiate ART after HIV diagnosis (AII) Disseminated MAC disease should be ruled out before starting primary prophylaxis Individuals exposed sexually within 90 days of the diagnosis of primary, secondary, or early latent syphilis of a sex partner, even if serologic test results are negative (AII), or Individuals exposed >90 days before syphilis diagnosis in a sex partner should be treated presumptively for early syphilis if serologic test results are not immediately available and the opportunity for follow-up is uncertain (AIII). CD4 count <150 cells/mcL and at high risk because of occupational exposure or living in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years) (BI)
Azithromycin 1,200 mg once weekly (AI), or Clarithromycin 500 mg twice daily (AI), or Azithromycin 600 mg twice weekly (BIII)
Rifabutin 300 mg daily (dose adjusted based on concomitant ART) (BI); rule out active TB before starting to avoid monotherapy
Syphilis
Benzathine penicillin G 2.4 million units IM for 1 dose (AII)
For penicillin-allergic patients: Doxycycline 100 mg twice daily for 14 days (BII), or Ceftriaxone 1 g IM or IV daily for 10–14 days (BII)
Histoplasma capsulatum infection
Itraconazole 200 mg daily (BI)
—
Coccidioidomycosis A new positive Coccidioides IgM or IgG test in patients
Fluconazole 400 mg daily (AIII)
—
who previously tested negative; do not have signs, symptoms, or laboratory abnormalities compatible with active disease; and have CD4 count <250 cells/ mcL Close contact with a person with chickenpox or herpes zoster and is susceptible (i.e., no history of vaccination or of either condition or known to be VZV seronegative) (AIII)
Varicella-zoster virus (VZV) infection (post-exposure)
Varicella-zoster immune globulin (VariZIG) 125 IU IM per 10 kg (maximum: 625 IU), administered as soon as possible and within 10 days after exposure (AIII) Recommendations are the same for HIV-infected and HIV-uninfected patients and are based on the region of travel, malaria risk, and drug susceptibility in the region.
Acyclovir 800 mg five times per day for 5–7 days (BIII), or Valacyclovir 1 g three times per day for 5–7 days (BIII)
Malaria
Travel to disease-endemic area
—
Table 1 continues on next page.
49
MDCT2026
Powered by FlippingBook