_______________________________________________________________________ HIV/AIDS: An Update
CHEMOPROPHYLAXIS TO PREVENT FIRST EPISODE OF OPPORTUNISTIC DISEASE AMONG ADULTS AND ADOLESCENTS INFECTED WITH HIV (Continued)
Opportunistic Infection Talaromycosis (Penicillosis)
Indication
Preventive Regimen
Preferred a
Alternative
Persons with HIV and CD4 cell counts <100 cells/mL, who are unable to have ART, or have treatment failure without access to effective ART options, and— Who reside in the highly endemic regions in northern Thailand, northern or southern Vietnam, or southern China (particularly in highland regions during rainy and humid months) (BI), or Who are from countries outside of the endemic region, and must travel to the region (BIII)
For persons who reside in endemic areas, itraconazole 200 mg once daily (BI) For those traveling to the highly endemic regions, begin itraconazole 200 mg once daily 3 days before travel, and continue for 1 week after leaving the endemic area (BIII)
For persons who reside in endemic areas, fluconazole 400 mg once weekly (BII) For those traveling to the highly endemic regions, take the first dose of fluconazole 400 mg 3 days before travel, continue 400 mg once weekly, and take the final dose after leaving the endemic area (BIII)
a All medications are taken orally unless otherwise indicated. Source: [50]
Table 1
RECOMMENDATIONS RATING SYSTEM
Category Definition Strength of Recommendation A Strong B Moderate C Weak Level of Evidence I
One or more randomized trials with clinical outcomes and/or validated laboratory endpoints
II
One or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes
III
Expert opinion
In addition to the recommended prophylaxis to prevent a first episode of opportunistic tuberculosis, guidelines for the treatment of HIV-related active tuberculosis were updated in 2024 [50]. In individuals with HIV infection, the ART regimen should be assessed with attention to potential interactions between ARTs and TB drugs, including rifamycin antibiotics (e.g., rifabutin, rifampin, rifapentine) and isoniazid, which have considerable potential for drug-drug interactions. For drug-susceptible TB, or if drug resistance is currently unknown, preferred therapy consists of an intensive phase of eight weeks with an initial four-drug combination of isoniazid, rifampin or rifabutin, ethambutol, and pyrazinamide daily until susceptibility to isoniazid and rifampin has been con- firmed [52]. If rapid drug sensitivity testing indicates resistance to isoniazid and rifampin, ethambutol may be immediately discontinued; if resistance is not indicated, ethambutol should
be discontinued until the end of the eight-week intensive phase. Continuation of therapy with the remaining three drugs may continue for 6 to 12 months, depending on clinical and/or bacteriologic response to therapy. Alternative preferred therapy used for patients receiving an efavirenz-based ART regimen that do not have extrapulmonary TB is isoniazid plus rifapentine plus moxifloxacin plus pyrazinamide plus pyridoxine. The con- tinuation of therapy is nine weeks of isoniazid plus rifapentine plus moxifloxacin plus pyridoxine daily [50]. For drug-resistant TB, empiric therapy for suspected resistance to rifamycin with or without resistance to other drugs is iso- niazid plus pyrazinamide plus ethambutol plus moxifloxacin or levofloxacin, plus linezolid or amikacin. For suspected or confirmed resistance to isoniazid, the recommended treatment is moxifloxacin or levofloxacin plus rifampin or rifabutin plus ethambutol plus pyrazinamide daily for six months. In patients
50
MDCT2026
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