skip to main content

Cryptosporidium Treatment in HIV — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

HardHIV MedicineCryptosporidium Treatment in HIVSCE Infectious Diseases

A 48-year-old man with advanced HIV (CD4 20) develops profuse watery diarrhoea and severe dehydration. Modified ZN stain of stool shows acid-fast oocysts of 4–5 µm. He is started on ART. Despite 4 weeks of ART with rising CD4 (now 80), diarrhoea persists. What adjunctive treatment may provide symptomatic benefit while awaiting immune reconstitution?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Nitazoxanide 500 mg BD (limited efficacy in severe immunosuppression but may provide partial benefit) plus aggressive supportive care (rehydration, nutrition)

Cryptosporidium (4–5 µm acid-fast oocysts) in advanced HIV has no reliably effective antimicrobial treatment. The definitive management is immune reconstitution with ART — Cryptosporidiosis typically resolves once CD4 >100. Nitazoxanide 500 mg BD may provide partial symptomatic benefit (FDA-approved for immunocompetent Cryptosporidiosis; limited evidence in HIV but can be tried). Supportive care is critical: aggressive oral/IV rehydration, nutritional support, and Loperamide for symptom control. Paromomycin has been tried but evidence is poor.

Reference: BHIVA 2022 – OI guidelines; WHO 2021 – Cryptosporidiosis; Cochrane 2023