Suggested OI prophylaxis in patients with HIV and cHL undergoing chemotherapy
| OI . | Threshold for prophylaxis . | Prophylactic regimens . |
|---|---|---|
| Pneumocystis jirovecii pneumonia | All patients during chemotherapy; continue after therapy until a CD4+ count >200 cells per mm3 is sustained for 3-6 mo. | Preferred |
| Trimethoprim/sulfamethoxazole, 800/160-mg tablet (Bactrim DS) Monday, Wednesday, and Friday | ||
| Trimethoprim/sulfamethoxazole, 400/80-mg tablet daily | ||
| Alternatives | ||
| Pentamadine, 300 mg in 6 mL of sterile water via nebulizer inhaler, once monthly | ||
| Atovaquone, 1500-mg suspension once daily | ||
| Dapsone, 100-mg tablet daily; mild hemolysis may be seen in patients with glucose-6-phosphate dehydrogenase deficiency | ||
| Trimethoprim/sulfamethoxazole and atovaquone may also prevent toxoplasmosis. | ||
| Herpes simplex virus 1/2 | All patients with history of oral or anogenital herpes simplex virus. Follow general recommendations for secondary prophylaxis starting 3-6 mo after completion of therapy. | Valacyclovir, 1000-mg tablet daily |
| Famciclovir, 500-mg tablet twice daily | ||
| Acyclovir, 400-mg tablet twice daily | ||
| These agents may also provide prophylaxis against varicella-zoster virus reactivation. | ||
| Candida albicans (especially oral thrush) | Consider primary prophylaxis when CD4+ count is <100 cells per mm3, or secondary prophylaxis with history of mucosal candidiasis. Alternatively, can be treated on earliest symptoms, especially when CD4+ count is >200 cells per mm3. | Fluconazole, 200-mg tablet once daily (or 3 times/wk); also prevents cryptococcal disease in HIV patients with CD4+ counts <100 cells per mm3; do not administer the day before or the day of chemotherapy |
| Nystatin oral suspension, 5 mL “swish and swallow” 2-4 times daily (may be included in oral mouthwashes used for management of mucositis) | ||
| Atypical mycobacteria (ie, Mycobacterium avium complex or Mycobacterium intracellulare) | CD4+ count <100 cells per mm3. Consider a higher current CD4+ threshold in patients with recent history of a nadir <100 cells per mm3 or history of atypical mycobacterial infection. | Azithromycin, 1200 mg weekly |
| OI . | Threshold for prophylaxis . | Prophylactic regimens . |
|---|---|---|
| Pneumocystis jirovecii pneumonia | All patients during chemotherapy; continue after therapy until a CD4+ count >200 cells per mm3 is sustained for 3-6 mo. | Preferred |
| Trimethoprim/sulfamethoxazole, 800/160-mg tablet (Bactrim DS) Monday, Wednesday, and Friday | ||
| Trimethoprim/sulfamethoxazole, 400/80-mg tablet daily | ||
| Alternatives | ||
| Pentamadine, 300 mg in 6 mL of sterile water via nebulizer inhaler, once monthly | ||
| Atovaquone, 1500-mg suspension once daily | ||
| Dapsone, 100-mg tablet daily; mild hemolysis may be seen in patients with glucose-6-phosphate dehydrogenase deficiency | ||
| Trimethoprim/sulfamethoxazole and atovaquone may also prevent toxoplasmosis. | ||
| Herpes simplex virus 1/2 | All patients with history of oral or anogenital herpes simplex virus. Follow general recommendations for secondary prophylaxis starting 3-6 mo after completion of therapy. | Valacyclovir, 1000-mg tablet daily |
| Famciclovir, 500-mg tablet twice daily | ||
| Acyclovir, 400-mg tablet twice daily | ||
| These agents may also provide prophylaxis against varicella-zoster virus reactivation. | ||
| Candida albicans (especially oral thrush) | Consider primary prophylaxis when CD4+ count is <100 cells per mm3, or secondary prophylaxis with history of mucosal candidiasis. Alternatively, can be treated on earliest symptoms, especially when CD4+ count is >200 cells per mm3. | Fluconazole, 200-mg tablet once daily (or 3 times/wk); also prevents cryptococcal disease in HIV patients with CD4+ counts <100 cells per mm3; do not administer the day before or the day of chemotherapy |
| Nystatin oral suspension, 5 mL “swish and swallow” 2-4 times daily (may be included in oral mouthwashes used for management of mucositis) | ||
| Atypical mycobacteria (ie, Mycobacterium avium complex or Mycobacterium intracellulare) | CD4+ count <100 cells per mm3. Consider a higher current CD4+ threshold in patients with recent history of a nadir <100 cells per mm3 or history of atypical mycobacterial infection. | Azithromycin, 1200 mg weekly |