Pharmacotherapy of Opportunistic Infections
Drug-by-Drug Treatment and Prophylaxis of PCP, Cryptococcosis, CMV, Toxoplasmosis, MAC and Mucosal Candidiasis in HIV
Past RGUHS · 3
RGUHSDec '23
RGUHSJul '23
RGUHSMay '10
Introduction
- An opportunistic infection (OI) is caused by an organism that is normally innocuous but becomes invasive once cell-mediated immunity fails. In HIV, OI risk tracks the falling CD4+ count — the single most useful pharmacotherapeutic trigger in this topic.
- Six OIs carry the examinable drug therapy — PCP, cryptococcal meningitis, CMV end-organ disease, toxoplasma encephalitis, disseminated MAC and mucosal candidiasis — each appearing at a predictable CD4 level.
- ART is itself the definitive anti-OI drug. Prophylaxis is only a time-limited bridge until immune restoration, chosen on the OI's local prevalence, the patient's immune status and access to ART.
- Polypharmacy is the norm and the hazard — overlapping organ toxicity and cytochrome-P450 interactions dominate practice. OI therapy is not interrupted for anything but intolerance, interaction or toxicity.
The CD4 ladder — which opportunistic infection appears at which CD4 count
| CD4 count (cells/mm3) | Opportunistic infection that becomes likely |
|---|---|
| 350–500 | Herpes zoster |
| ≤350 | Tuberculosis |
| ≈250 | Oral candidiasis |
| <200 | PCP · oesophageal candidiasis · mucocutaneous herpes |
| <100 | Toxoplasmosis · cryptococcosis · cryptosporidiosis · PML |
| <50 | CMV end-organ disease · disseminated MAC |
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Opportunistic Infections Pharmacotherapy
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