Toxoplasma Prophylaxis Timing — SCE Infectious Diseases MCQ
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Correct answer: C — No prophylaxis at this CD4 — only needed below CD4 200
Toxoplasma IgG positivity in a person with HIV indicates previous exposure/latent infection, not active toxoplasmosis. In an asymptomatic patient with CD4 300 cells/mm³ and fully suppressed viral load on ART, primary anti-Toxoplasma prophylaxis is not indicated. UK practice/exam teaching is that prophylaxis is reserved for substantially immunosuppressed Toxoplasma-seropositive patients, classically when CD4 falls below 200 cells/mm³; co-trimoxazole is then used because it also provides Pneumocystis jirovecii pneumonia prophylaxis. A CD4 threshold of <350 is not an indication, and pyrimethamine alone, dapsone alone or atovaquone-only are not appropriate here. Therefore the correct answer is no prophylaxis at this CD4 count.
Reference: British HIV Association (BHIVA) and British Infection Association. Guidelines for the treatment of opportunistic infection in HIV-seropositive individuals 2011, section 2.5 Toxoplasma gondii/prophylaxis. https://bhiva.org/wp-content/uploads/2024/11/-file-SwhaEzgXmAGOt-hiv_v12_is2_Iss2Press_Text.pdf