Human Immunodeficiency Virus Book

Approach

Miscellaneous

Prevention

  • Pneumocystis prophylaxis

http://www.fpnotebook.com/

Pneumocystis prophylaxisAka: Pneumocystis jiroveci prophylaxis, PCP Prophylaxis

Advertisement

  1. See Also
    1. Pneumocystis carinii (Pneumocystis jiroveci)
  2. Indications to start prophylaxis
    1. CD4 Count < 200
    2. Constitutional symptoms regardless of CD4 Count
      1. Oral Candidiasis (Thrush)
      2. Unexplained fever > 2 weeks
    3. Prior history of Pneumocystis
      1. Second episode PCP Pneumonia within 1 year: 30-60%
  3. Indications to stop prophylaxis
    1. CD4 Count > 200 and
    2. Triple Antiretroviral therapy >6 months
    3. Also applies to MAC, Cryptococcus, Toxoplasmosis
    4. References
      1. (2002) Ann Intern Med 137(4):239
  4. Efficacy
    1. Bactrim QD extremely effective in preventing PCP
    2. Also decreases the Incidence of bacterial infections
    3. Decreases the Incidence of Toxoplasmosis Encephalitis
      1. Patients with previous Toxoplasmosis infection
  5. Dosing
    1. Bactrim SS qd (First Line)
      1. More effective then other measures when CD4 < 200
      2. Prevents first and recurrent episodes of Pneumocystis
    2. Aerosolized Pentamidine
      1. 300 mg q month reduces the risk of PCP by 60-80%
      2. Well tolerated (cough and bronchospasm in 50-66)
    3. Dapsone 100 mg PO qd
      1. Add Pyrimethamine for Toxoplasmosis coverage
    4. Aerosolized Pentamidine 300 mg monthly
  6. Adverse Effects
    1. Significantly reduced adverse effects with Bactrim SS
      1. Bactrim DS no more effective than Bactrim SS
      2. Reference
        1. Schneider (1995) J Infect Dis 171:1632
    2. Adverse reactions to Bactrim in >3 months of use
      1. Requires discontinuation in 25% of patients

Navigation Tree