User:Gmoren5/Opportunistic infections
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Article Draft
Talk:
Hello, I am a fourth-year medical student participating in the WikiMed course at my university. I’m excited to be able to participate in this article and would welcome any suggestions or advice for my following edits. I am mainly focused on the prophylactic medication section. I want to add other infections we should be aware of when starting prophylactic medications. I also want to add more information on the indication sections, as CD4 count is not the only indication to start prophylactic medication. I want to add a new section discussing when it is appropriate to discontinue the medication. And finally, I want to update and add alternative medications when suggesting the agent.
Below is the bibliography, where I will be referring to the information. Thank you in advance for your suggestions and advice.
https://www.eacsociety.org/media/final2021eacsguidelinesv11.0_oct2021.pdf --> EU society guidelines for opportunistic infections, last updated in 2021
https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-oi/guidelines-adult-adolescent-oi.pdf --> CDC and NIH guidelines for opportunistic infections, updated regularly
https://www.ncbi.nlm.nih.gov/books/NBK567851/pdf/Bookshelf_NBK567851.pdf --> New York clinical guideline for HIV care, updated in 2021
Lead
Prophylactic medications
Article body
| Opportunistic infections | Indication(s) for prophylactic medications | Preferred agent(s) or (alternative agent) | When to discontinue agent(s) | Secondary prophylactic/maintenance agent(s) |
|---|---|---|---|---|
| Mycobacterium tuberculosis | Upon diagnosis of HIV, any positive screening test, or prior medical history of Mycobacterium tuberculosis. | Rifampicin | These agents will discontinue after two months. | Rifampicin, isoniazid, and pyridoxine will continue for at least four more months, depending on clinical presentation. |
| Pneumocystis jiroveci | CD4 count is less than 200 cells/mm3 or less than 14%. The person has documented medical history of recurrent oropharyngeal candidiasis. | Trimethoprim-sulfamethoxazole | These agent(s) will discontinue after 21 days. Secondary prophylactic agents will continue until the CD4 count is above 200 cells/mm3 and HIV viral load is undetectable for at least three months while taking antiretroviral therapy. | Trimethoprim-sulfamethoxazole |
| Toxoplasma gondii | CD4 count is less than 100 cells/mm3 or less than 14%, and the person has a positive serology for Toxoplasma gondii. | Trimethoprim-sulfamethoxazole | These agent(s) will discontinue after six weeks. Secondary prophylactic medications will continue until the CD4 count is above 200 cells/mm3 and HIV viral load is undetectable for at least six months while taking antiretroviral therapy. | Sulfadiazine, pyrimethamine, and folinic acid. |
| Mycobacterium avium complex disease | CD4 count is less than 50 cells/mm3 and has a detectable viral load while taking antiretroviral therapy. | Clarithromycin and ethambutol
Rifabutin may be added depending on clinical presentation. |
These agent(s) will discontinue after 12 months only if the person does not have any symptoms that will be concerning for persistent Mycobacterium avium complex disease and their CD4 count is above 100 cells/mm3, and while their HIV viral load is undetectable for at least six months while taking antiretroviral therapy. | N/A |
Alternative agents can be used instead of the preferred agents. These alternative agents may be used due to allergies, availability, or clinical presentation. The alternative agents are listed in the table below.
| Opportunistic infections | Alternative agent(s) |
|---|---|
| Mycobacterium tuberculosis | Rifabutin |
| Pneumocystis jiroveci | |
| Toxoplasma gondii | Dapsone, pyrimethamine, and folinic acid
Atovaquone, pyrimethamine, and folinic acid |
| Mycobacterium avium complex disease | Azithromycin and ethambutol |
References
https://www.eacsociety.org/media/final2021eacsguidelinesv11.0_oct2021.pdf --> EU society guidelines for opportunistic infections, last updated in 2021
https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-oi/guidelines-adult-adolescent-oi.pdf --> CDC and NIH guidelines for opportunistic infections, updated regularly
https://www.ncbi.nlm.nih.gov/books/NBK567851/pdf/Bookshelf_NBK567851.pdf --> New York clinical guideline for HIV care, updated in 2021