Cryptosporidiosis in HIV — DTM&H MCQ

Correct answer: D — Optimise antiretroviral therapy and provide aggressive supportive care

The correct answer is D, optimise antiretroviral therapy and provide aggressive supportive care. In a child with advanced HIV and profuse watery diarrhoea due to Cryptosporidium, the underlying driver of severe, prolonged infection is CD4 depletion rather than a drug-treatable pathogen state, so immune reconstitution through ART is the single most important intervention. No antiparasitic agent reliably eradicates Cryptosporidium in the immunocompromised host; restoring cellular immunity allows the host to clear the organism, while rehydration and nutritional support prevent death from fluid and electrolyte loss in the interim. This matches UK primary care guidance stating that in HIV patients highly active antiretroviral therapy is the treatment of choice for cryptosporidiosis. The stem's discriminators, chronicity of diarrhoea and advanced HIV in a child, point directly to immune-driven pathogenesis needing ART plus supportive care rather than pathogen-specific chemotherapy. Why the other options are wrong: E. Praziquantel as definitive therapy: praziquantel is an anthelminthic active against trematodes and cestodes (for example schistosomiasis), and has no activity against the protozoan Cryptosporidium. B. Amphotericin B induction: amphotericin B is an antifungal used for invasive mycoses such as cryptococcal meningitis, not for protozoal enteric infection, and has no role here. C. Chloroquine for 3 days: chloroquine is an antimalarial (and used in some rheumatological conditions) with no antiprotozoal activity against Cryptosporidium. A. Corticosteroids to reduce gut inflammation: steroids would further suppress an already impaired immune system, worsening oocyst shedding and diarrhoea, and are not indicated outside specific IRIS scenarios unrelated to this presentation. Key point: chronic cryptosporidial diarrhoea in advanced paediatric HIV is managed by immune reconstitution with ART plus aggressive rehydration and nutritional support, since no antiparasitic drug reliably cures the infection in this population.

Reference: GPNotebook (Primary Care Notebook), Cryptosporidial diarrhoea: Treatment, https://primarycarenotebook.com/pages/infectious-disease/cryptosporidial-diarrhoea/treatment