II. Indications: Start prophylaxis
- CD4 Count < 200
- Constitutional symptoms regardless of CD4 Count
- Oral Candidiasis (Thrush)
- Unexplained fever > 2 weeks
- Prior history of Pneumocystis
- Second episode PCP Pneumonia within 1 year: 30-60%
III. Indications: Stop prophylaxis
- CD4 Count > 200 (stable for at least 3 months) and
- Triple Antiretroviral therapy >6 months
- Also applies to MAC, Cryptococcus, Toxoplasmosis
- References
IV. Efficacy
- Bactrim daily is extremely effective in preventing PCP
- Also decreases the Incidence of Bacterial Infections
- Decreases the Incidence of ToxoplasmosisEncephalitis
- Patients with previous Toxoplasmosis infection
V. Dosing: First line
VI. Dosing: Other agents
-
Aerosolized Pentamidine
- Adults: 300 mg every 4 weeks reduces the risk of PCP by 60-80%
- Well tolerated (cough and bronchospasm in 50% of patients)
-
Dapsone 100 mg PO qd
- Add Pyrimethamine for Toxoplasmosis coverage
- Screen for G6PD prior to use