OI Prevention
Staging of HIV Infection
Stage 0 - Early infection
Stage 1 = CD4 > 500 (>26%); no AIDS-defining condition
Stage 2 = CD4 200-499 (14-25%); no AIDS defining condition
Stage 3 = CD4 < 200 (<14%); documented AIDS-defining condition
Stage Unknown = no information available
PJP
SMX/TMP (Preferred)
Dapsone
Atovaquone
Pentamidine
Primaquine
Pharmacists' Role
Talk about PrEP with patients
Linkage to care
Barrier elimination
- Insurance
- Adherence
- Failed regimens?
- Available resources
Common OIs Requiring Primary Prophylaxis
1. PJP - CD4 <200
2. Toxoplasmosis <100 (if seropositive)
3. Disseminated Mycobacterium avium complex (MAC)
Toxoplasmosis
Pyrimethamine + sulfadiazine + leucovorin or
Pyrimethamine + clindamycin + leucovorin or
Atovaquone + sulfadiazine or
SMX/TMP
Speaking of Resources...
DHHS and IDSA Guidelines
CDC
AETC National HIV Curriculum
Ryan White HIV/AIDS Program
Common OIs NOT Requiring Primary Prophylaxis
1. Latent TB - Test for LTBI at time of diagnosis and annually if at high risk/ongoing exposure
2. Candidiasis
3. Cryptococcal Meningitis
4. Cytomegalovirus (CMV)
5. Histoplasmosis (only if in endemic regions)
6. Coccidiodomycosis
MAC
Macrolide for MAC
Alt Rifabutin
The case of vaccines
1. Screen for HAV and HBV screening
2. Test for HCV - no vaccine available
3. HPV
4. Pneumococcal conjugate
5. Meningococcal B
6. Herpes zoster
7. Monkeypox
Mucocutaneous Candidiasis
Increases with CD4 <200
- Oropharyngeal: Diflucan 100 mg x 7-14 Days
- Esophageal: Diflucan 100-400 mg x 14-21 Days
- Vulvovaginitis: Diflucan 150 mg X 1 dose
Bacterial Enteric Infections
1. Salmonella
2. Shigella
3. Campylobacter
4. E. coli
5. Clostridioides difficile
CMV Retinitis and Cryptococcal Meningitis
CMV
Intravitreal ganciclovir + PO Valganciclovir x 14-21 days
Cryptococcal Meningitis
Induction phase - Liposomal amphotericin B + flucytosine x 2 weeks
Consolidation Phase - Fluconazole X 8 weeks