Box 1: Primary prophylaxis of opportunistic infections with antimicrobial therapy in patients with HIV infection10
Opportunistic infectionCD4 count, cells/μLIndicationRegionsRecommended prophylaxis (first line)
Tuberculosis (treatment of latent tuberculosis infection)All countsPositive tuberculin skin test or interferon-γ release assay result without evidence of active disease or previous treatment for active or latent tuberculosisAll regionsIsoniazid, 300 mg/d orally, + pyridoxine, 25–50 mg/d orally
Coccidiodomycosis< 250New positive result of IgM or IgG Coccidiodes spp. serologic testing (monitored annually if residence in endemic area)Southern California, Arizona; southern Utah, Nevada, New Mexico; western TexasFluconazole, 400 mg/d orally
Pneumocystis jirovecii pneumonia< 200All patients with CD4 count < 200 cells/μLAll regionsTrimethroprim–sulfamethoxazole, 1 tablet single strength orally daily
Histoplasmosis≤ 150

  • Residence in or travel to hyperendemic area

  • High-risk activity (exploring caves, occupational exposure to bird or bat droppings) in endemic areas

  • French Guiana, some other regions of South America

  • Mississippi, Ohio, St. Lawrence River valleys; Caribbean, southern Mexico

  • Some regions of Central America, Africa, Asia

Itraconazole, 200 mg/d orally
Talaromycosis< 100Residence in or travel to endemic areaNorthern Thailand, Vietnam, southern ChinaItraconazole, 200 mg/d orally
Toxoplasmosis< 100Positive result of IgG Toxoplasma gondii serologic testingAll regionsTrimethroprim–sulfamethoxazole, 1 tablet double strength orally daily
Mycobacterium avium complex< 50Not receiving fully suppressive antiretroviral therapy after active Mycobacterium avium complex ruled outAll regionsAzithromycin, 1200 mg orally once weekly