CAP in Well-Controlled HIV — SCE Infectious Diseases MCQ

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EasyRespiratory InfectionCAP in Well-Controlled HIVSCE Infectious Diseases

A 35-year-old man with well-controlled HIV (CD4 600, VL <50) develops community-acquired pneumonia. CURB-65 is 0. He is systemically well. Should his HIV status alter the antibiotic choice for his CAP?

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Correct answer: E — No — well-controlled HIV with normal CD4 does not alter CAP antibiotic recommendations; treat per standard NICE guidelines (Amoxicillin 500 mg TDS for 5 days for low-severity CAP)

In well-controlled HIV with CD4 >200 and suppressed VL, standard CAP guidelines apply. The immune reconstitution makes the patient's infection susceptibility comparable to HIV-negative individuals. CURB-65 = 0 indicates low-severity CAP manageable with oral Amoxicillin as an outpatient. Dual therapy (adding a macrolide) is only needed for moderate-severe CAP. The principle of normalised management in well-controlled HIV extends to common infections like CAP.

Reference: NICE NG138 2023 – Pneumonia; BHIVA 2025 – Primary care HIV management