II. Causes: General
-
Bacterial Pneumonia that recurs for at least two episodes in 12 months
- Invasive pneumococcal infection is 10-20x more common in HIV
- Candidiasis of the Bronchopulmonary Tract (Bronchi, trachea, lungs) or Esophageal Candidiasis
- Coccidioidomycosis (disseminated or extrapulmonary)
- Extrapulmonary Cryptococcus neoformans (esp. Cryptococcal Meningitis)
- Chronic intestinal Cryptosporidium (persistent >1 month)
- Cytomegalovirus infection (beyond liver, Spleen and Lymph Nodes) or CMV Retinitis
- Herpes Simplex Virus (chronic HSV ulcer present >1 month, HSV Bronchitis, HSV pneumonitis, or HSV Esophagitis)
- Herpes Zoster (disseminated)
- Oral Hairy Leukoplakia (EBV infection related)
- Histoplasmosis (diseminated or extrapulmonary)
- Isosporiasis (Chronic intestinal present >1 month)
- Mycobacterium Avium Complex disease
- Mycobacterium kansaii
- Mycobacterium tuberculosis (pulmonary or extrapulmonary)
- Pneumocystis Pneumonia (Pneumocystis jiroveci replaces previously named Pneumocystis carinii or PCP)
- Salmonella Sepsis
- Toxoplasmosis gondii
III. Risk Factors
- Opportunistic Infections typically occur when CD4 Lymphocyte Count <200 cells/uL (may occur at higher levels)
IV. Prevention
- Immunizations
-
Pneumocystis jiroveci
- Start prophylaxis at <200 cells/mm3 (and stop when >200 cells/mm3 for 3 months)
- Prophylaxis with Bactrim DS or SS once daily
-
Toxoplasmosis gondii
- Start prophylaxis at <100 cells/mm3 (and stop when >200 cells/mm3 for 3 months)
- Prophylaxis with Bactrim DS once daily
-
Mycobacterium Avium Complex
- Start prophylaxis at <50 cells/mm3 (and stop when >100 cells/mm3 for 3 months)
- Prophylaxis with Azithromycin 1200 mg weekly (or 600 mg twice weekly)