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Opportunistic Infections in HIV

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Opportunistic Infections in HIV, Antibiotic Prophylaxis of Opportunistic Infection in HIV

  1. Bacterial Pneumonia that recurs for at least two episodes in 12 months
  2. Candidiasis of the Bronchopulmonary Tract (Bronchi, trachea, lungs) or Esophageal Candidiasis
  3. Coccidioidomycosis (disseminated or extrapulmonary)
  4. Extrapulmonary Cryptococcus (esp. Cryptococcal Meningitis)
  5. Chronic intestinal Cryptosporidium (persistent >1 month)
  6. Cytomegalovirus infection (beyond liver, Spleen and Lymph Nodes) or CMV Retinitis
  7. Herpes Simplex Virus (chronic HSV ulcer present >1 month, HSV Bronchitis, HSV pneumonitis, or HSV Esophagitis)
  8. Histoplasmosis (diseminated or extrapulmonary)
  9. Isosporiasis (Chronic intestinal present >1 month)
  10. Mycobacterium Avium Complex disease
  11. Mycobacterium kansaii
  12. Mycobacterium tuberculosis (pulmonary or extrapulmonary)
  13. Pneumocystis Pneumonia (Pneumocystis jiroveci replaces previously named Pneumocystis carinii or PCP)
  14. Salmonella Sepsis
  15. Toxoplasmosis gondii
  • Risk Factors
  1. Opportunistic Infections typically occur when CD4 Lymphocyte Count <200 cells/uL (may occur at higher levels)
  • Prevention
  1. Immunizations
    1. See Immunization in HIV
  2. Pneumocystis jiroveci
    1. Start prophylaxis at <200 cells/mm3 (and stop when >200 cells/mm3 for 3 months)
    2. Prophylaxis with Bactrim DS or SS once daily
  3. Toxoplasmosis gondii
    1. Start prophylaxis at <100 cells/mm3 (and stop when >200 cells/mm3 for 3 months)
    2. Prophylaxis with Bactrim DS once daily
  4. Mycobacterium Avium Complex
    1. Start prophylaxis at <50 cells/mm3 (and stop when >100 cells/mm3 for 3 months)
    2. Prophylaxis with Azithromycin 1200 mg weekly (or 600 mg twice weekly)
  • References
  1. GoldSchmidt (2016) Am Fam Physician 94(9): 708-16 [PubMed]