HIV: Drug regimens for primary and secondary prophylaxis for the most common opportunistic infections

Pathogen

Primary

Secondary

Pneumocystis carinii

CD4<200>

Cotrimoxazole (160 mg trimethoprim + 800 mg sulfamethoxazole qd, 3d/week).

Dapsone 100 mg + pyrimethamine 50 mg 2d/week.

Aerosolised pentamidine 300 mg/month.

Fansidar (500/25 mg), 1-2 days/week.

Previous episode of PCP

Cotrimoxazole dosage identical to the primary prophylaxis

Aerosolised pentamidine, 300 mg/15d.

Pentamidine IV or IM, 4 mg/kg/month.

Dapsone, 100 mg/d or 200 mg/week.

Fansidar (500/25 mg), 1-2/week.

Toxoplasma gondii

CD4<100>

Cotrimoxazole (160/800 mg) qd, 3d/week.

Dapsone, 100 mg + Pyrimethamine 50 mg, 2 d/week.

Pyrimethamine, 50 mg 3 d/week (+ folinic acid).

Previous episode of toxoplasmosis

Sulphadiazine 2 g + pyrimethamine 25 mg + folinic acid 10 mg qd, daily;

or sulphadiazine 2 gr + pyrimethamine 50 mg + folinic acid 10 mg qd 3 days per week

Clindamycin, 600 mg tid + pyrimethamine,

25 mg + folinic acid, 10 mg qd. Clarithromycin 500 mg/12 h + pyrimethamine, 25 mg + folinic acid, 10 mg/d

Leishmania donovani

No

Previous episode of leishmaniasis

Glucantime 20 mg/Kg/15-30 days

Isospora belli

No

Previous episode of isosporiasis

Cotrimoxazole (160 mg trimethoprim + 800 mg sulphamethoxazole), 3 days/week.

Fansidar 1 tablet/week

Cryptococcus

neoformans

CD4<50>

Fluconazole 100-200 mg qd

Previous episode of cryptococcosis

Fluconazole 200 mg qd.

Amphotericin B 100 mg/week IV

Candida sp.

No

Severe recurrent candidiasis

Topical nystatin or miconazole.

Fluconazole 50-100 mg qd

Ketoconazole 200-400 mg qd

Amphotericin B 0.2-0.3 mg/kg/d IV (oesophageal or Candida resistant to imidazoles).

Cytomegalovirus

CD4<50>

Ganciclovir 1 g tid oral

Previous episode of retinitis

Ganciclovir 5 mg/kg/d IV 5 d/week or 10 mg/kg/d 3 d/week or ganciclovir orally 1 g tid.

Foscarnet 120 mg/kg/d IV in 2-3 h, 5 d/week.

Cidofovir 5 mg/kg IV + probenecid every 2 weeks.

Herpes simplex

No

Frequent recurrence

Aciclovir 200 mg tid or 400 mg bid

Famciclovir 500 mg bid

Valaciclovir 500 mg bid

Herpes zoster

Recent contact with VVZ and no prior incidents.

VZIG 5 vials (of 1.25 ml) IM 48-96 h after exposure.

Frequent recurrence

Aciclovir 800 mg bid or tid, if recurrence is frequent.

Famciclovir 500 mg bid

M. tuberculosis

PPD+ (current or previous) without prophylaxis or prior treatment.

Recent contact with open TB.

Isoniazid 300 mg qd or 900 mg 2d/week, for 9 months.

Rifampin 600 mg + pyrazinamide 20 mg/kd/d, 2 months

Rifampin 600 mg/d for 4 months if there is a high probability of exposure to isoniazid-resistant TB.

No

M. avium-complex

CD4<50

Azithromycin 1200 mg/week

Clarithromycin 500 mg bid

Rifabutin 300 mg qd

Lifelong treatment

Histoplasma

capsulatum

CD4<100,>

Itraconazole 200 mg qd

Previous episode of histoplasmosis

Itraconazole 200 mg bid

Amphotericin B 1 mg/kg/week IV

Coccidioides immitis

No

Previous episode of coccidioidomycosis

Fluconazole 400 mg qd

Amphotericin B 1 mg/kg/week IV

Itraconazole 200 mg/12 h

Salmonella sp. (non-typhi)

No

Episode of bacteraemia

Ciprofloxacin 500 mg bid during several months

Streptococcus

pneumoniae

CD4>200

Antipneumococcal vaccination 0.5 ml IM every 5 years.

If previous dosage was applied when CD4<200,>200, then revaccinate

Hepatitis B

Negative markers for hepatitis B

Hepatitis B vaccination (3 doses)

Influenza

HIV+, Flu vaccination 0.5 ml/year IM