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Question 1

When is the HIV infected patient at risk of opportunistic
infections and malignancy?
CD4 cell count: 200-500 cells/l - Herpes Zoster,
Pneumococcal pneumonia, Oral candidiasis, Tuberculosis
50-200 cells/l - PJP, CNS Toxoplasmosis, Cryptococcosis,
Kaposi’s sarcoma, NHL, PCNS lymphoma
Less than 50 cells/l - Disseminated MAC, CMV retinitis,
Cryptosporidiosis

Answer 1

Primary and Secondary OI Prophylaxis
* Initiation of PRIMARY prophylaxis at CD4 cells <200 for PCP and CNS toxoplasmosis –
Cotrimoxazole DS 1 daily. CD4 cells <50 – azithromycin 1g weekly
* SECONDARY prophylaxis continued after induction treatment for OI, until immune
restoration on ART
* Cessation of prophylaxis for:-
PCP, CNS toxoplasmosis, Cryptococcosis – CD4 cells >200 for 3-6 months, completed
induction therapy and asymptomatic
MAC – CD4 cells >100 for 3-6 months, completed 12 months treatment for MAC and
asymptomatic
CMV retinitis – CD4 cells >100-150 for 6 months
* Prophylaxis should be re-instituted if CD4 cells drop below 150-200 cells