A 37-year-old man comes to the office due to generalized fatigue and weight loss over the last 6 months. He has not had skin rash, fevers, night sweats, cough, or diarrhea. The patient was diagnosed with HIV 6 years ago and does not take antiretroviral medications.
Vital signs are normal and BMI is 18 kg/m². Physical examination shows small, mobile submandibular lymph nodes. Mucous membranes are moist with no lesions. The lungs are clear to auscultation. There is no organomegaly on abdominal examination.
Laboratory results are as follows:
In addition to antiretroviral therapy, prophylaxis against which of the following pathogens should be initiated in this patient?

Question

A 37-year-old man comes to the office due to generalized fatigue and weight loss over the last 6 months. He has not had skin rash, fevers, night sweats, cough, or diarrhea. The patient was diagnosed with HIV 6 years ago and does not take antiretroviral medications.
Vital signs are normal and BMI is 18 kg/m². Physical examination shows small, mobile submandibular lymph nodes. Mucous membranes are moist with no lesions. The lungs are clear to auscultation. There is no organomegaly on abdominal examination.
Laboratory results are as follows:

In addition to antiretroviral therapy, prophylaxis against which of the following pathogens should be initiated in this patient?

Quizplus · Accepted Answer

11ec193a_9857_539d_853d_c53b762e04a6_MD0002_00 All patients with HIV, regardless of CD4 count, should be prescribed antiretroviral therapy. Prophylaxis against common opportunistic infections is recommended based upon CD4 count and exposure risk, as follows: Pneumocystis jirovecii pneumonia prophylaxis is primarily recommended for patients who have CD4 counts <200/mm³. First-line therapy is daily trimethoprim-sulfamethoxazole (TMP-SMX); second-line medications include dapsone, atovaquone, and pentamidine. Testing for glucose-6-phosphate dehydrogenase deficiency is required prior to the initiation of dapsone.Toxoplasma gondii prophylaxis is recommended for patients who have CD4 counts <100/mm³ and positive Toxoplasma IgG serology. First-line therapy is TMP-SMX; second-line medications are shown in the table above.Histoplasma infection prophylaxis with itraconazole is sometimes considered for patients who live in endemic areas and have CD4 counts <150/mm³. Pneumocystis jirovecii pneumonia prophylaxis is primarily recommended for patients who have CD4 counts <200/mm³. First-line therapy is daily trimethoprim-sulfamethoxazole (TMP-SMX); second-line medications include dapsone, atovaquone, and pentamidine. Testing for glucose-6-phosphate dehydrogenase deficiency is required prior to the initiation of dapsone. Pneumocystis jirovecii pneumonia prophylaxis is primarily recommended for patients who have CD4 counts <200/mm³. First-line therapy is daily trimethoprim-sulfamethoxazole (TMP-SMX); second-line medications include dapsone, atovaquone, and pentamidine. Testing for glucose-6-phosphate dehydrogenase deficiency is required prior to the initiation of dapsone. ³ Toxoplasma gondii prophylaxis is recommended for patients who have CD4 counts <100/mm³ and positive Toxoplasma IgG serology. First-line therapy is TMP-SMX; second-line medications are shown in the table above. Toxoplasma gondii prophylaxis is recommended for patients who have CD4 counts <100/mm³ and positive Toxoplasma IgG serology. First-line therapy is TMP-SMX; second-line medications are shown in the table above. ³ Histoplasma infection prophylaxis with itraconazole is sometimes considered for patients who live in endemic areas and have CD4 counts <150/mm³. Histoplasma infection prophylaxis with itraconazole is sometimes considered for patients who live in endemic areas and have CD4 counts <150/mm³. ³ Mycobacterium avium complex prophylaxis was previously recommended for those with CD4 counts <50/mm³, but prophylaxis against this pathogen is no longer recommended due to low overall incidence (even in those with advanced AIDS) and the risk of developing macrolide-resistant pathogens. Cryptococcus neoformans prophylaxis is not recommended; the most effective way to prevent Cryptococcus is to initiate antiretroviral therapy. Routine prophylaxis against other common opportunistic infections (eg, cytomegalovirus) is not currently recommended. ³ Educational objective: In patients with advanced HIV, trimethoprim-sulfamethoxazole is the preferred first-line treatment for prevention of pneumocystis (CD4 counts <200/mm³) and toxoplasma (CD4 counts <100/mm³ and positive IgG). Prophylaxis against Mycobacterium avium complex is no longer recommended. Routine fungal prophylaxis is not generally required, but patients who live in Histoplasma-endemic regions often receive preventive treatment when CD4 counts are <150/mm³. All patients with HIV should be prescribed antiretroviral therapy. ³ ³ ³ __________

A 37-Year-Old Man Comes to the Office Due to Generalized