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Brief Summary

GUIDELINE TITLE

Prevention of secondary disease: opportunistic infections.

BIBLIOGRAPHIC SOURCE(S)

  • New York State Department of Health. Prevention of secondary disease: opportunistic infections. New York (NY): New York State Department of Health; 2006 Nov. 2 p.

GUIDELINE STATUS

This is the current release of the guideline.

BRIEF SUMMARY CONTENT

 
RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Clinicians should initiate prophylaxis for specific opportunistic infections as indicated in Table 1 below and discontinue prophylaxis as indicated in Table 2 below.

Table 1 Initiation of Primary Opportunistic Infection (OI) Prophylaxis

Pathogen Initiate Prophylaxis Preferred Agent Alternative Agents
Pneumocystis jirovecii pneumonia* CD4 <200 cells/mm3 or <14%, or a history of oropharyngeal candidiasis Trimethoprim-Sulfamethoxazole (TMP/SMX) every day (qd) or 3x/wk
  • Dapsone**
  • Dapsone** + pyrimethamine + leucovorin
  • Atovaquone
  • Aerosolized pentamidine
Mycobacterium avium complex (MAC) CD4 <50 cells/mm3 Azithromycin
Clarithromycin
  • Rifabutin
  • Azithromycin + rifabutin
Toxoplasma encephalitis (TE) CD4 <100 cells/mm3
and
Positive serology for Toxoplasma (immunoglobulin G [IgG]+)
TMP/SMX qd
  • Dapsone** + pyrimethamine + leucovorin
  • Atovaquone with or without pyrimethamine + leucovorin
Cytomegalovirus (CMV) Not routinely recommended NA NA
Cryptococcus neoformans Not routinely recommended NA NA
Candida sp. Not routinely recommended NA NA

*Formerly Pneumocystis carinii.
**Screen for G6PD deficiency before initiating dapsone.

For more information on management of opportunistic infections, refer to the New York State Health Department guideline, Infectious Complications Associated With HIV Infection guidelines developed by the Medical Care Criteria Committee.

Table 2 Discontinuation of OI Prophylaxis

Pathogen Discontinuation of Primary Prophylaxis Discontinuation of Secondary Prophylaxis
Pneumocystis jirovecii pneumonia (PCP) Patient receiving highly active antiretroviral therapy (HAART) with increase in CD4 count to >200 cells/mm3 for >3 months
  • CD4 count >200 cells/mm3 for >3 months in response to HAART
  • Adequate viral suppression
  • If PCP occurred with CD4 >200 cells/mm3, prophylaxis should be maintained
Toxoplasma encephalitis (TE)* Patient receiving HAART with increase in CD4 count to >200 cells/mm3 for >3 months
  • CD4 count >200 cells/mm3 for >6 months in response to HAART
  • Completed initial therapy
  • Asymptomatic for TE
Mycobacterium avium complex (MAC) CD4 count increase to >100 cells/mm3 for >3 months in response to HAART
  • CD4 count increase to >100 cells/mm3 for >6 months in response to HAART
  • Completed at least 12 months of treatment for disseminated MAC**
  • Asymptomatic for MAC
Cryptococcosis NA
  • CD4 count increase to >100 to 200 cells/mm3 for >6 months
  • Completed initial therapy
  • Asymptomatic for cryptococcosis
Cytomegalovirus (CMV) NA
  • CD4 >100 to 150 cells/mm3 for >6 months
  • No evidence of active disease
  • Regular ophthalmic examination

*HIV-infected adults or adolescents with a history of toxoplasmosis in childhood should be administered lifelong prophylaxis to prevent recurrence.
**Obtaining blood cultures or bone marrow cultures may be advisable to ascertain disease activity.

CLINICAL ALGORITHM(S)

None provided

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is not specifically stated for each recommendation.

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

  • New York State Department of Health. Prevention of secondary disease: opportunistic infections. New York (NY): New York State Department of Health; 2006 Nov. 2 p.

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

2006 Dec

GUIDELINE DEVELOPER(S)

New York State Department of Health - State/Local Government Agency [U.S.]

SOURCE(S) OF FUNDING

New York State Department of Health

GUIDELINE COMMITTEE

Not stated

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Not stated

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

GUIDELINE STATUS

This is the current release of the guideline.

GUIDELINE AVAILABILITY

AVAILABILITY OF COMPANION DOCUMENTS

PATIENT RESOURCES

None available

NGC STATUS

This NGC summary was completed by ECRI Institute on June 28, 2007.

COPYRIGHT STATEMENT

DISCLAIMER

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