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PJP vs Toxoplasma Prophylaxis — SCE Infectious Diseases MCQ

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EasyHIV MedicinePJP vs Toxoplasma ProphylaxisSCE Infectious Diseases

A 30-year-old man with recently diagnosed HIV has a CD4 count of 180 cells/µL. He is Toxoplasma IgG NEGATIVE. What primary prophylaxis is still recommended and against what?

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Correct answer: E — Co-trimoxazole 960 mg daily for PJP prophylaxis (Toxoplasma prophylaxis is NOT needed as he is IgG negative — no latent infection to reactivate)

PJP prophylaxis is indicated at CD4 <200 regardless of Toxoplasma IgG status. Co-trimoxazole 480 mg or 960 mg daily covers PJP. ADDITIONAL Toxoplasma prophylaxis (requiring the higher 960 mg dose or specific anti-Toxoplasma agents) is only needed if Toxoplasma IgG is POSITIVE, indicating latent infection at risk of reactivation. In this Toxoplasma IgG-negative patient, the standard PJP prophylactic dose is sufficient — he has no latent Toxoplasma to reactivate. He should be advised to avoid raw/undercooked meat and cat litter to prevent primary Toxoplasma acquisition.

Reference: BHIVA 2022 – OI guidelines; WHO 2021 – OI prophylaxis