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Advanced HIV opportunistic infection prophylaxis — ABIM Board MCQ

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ModerateInfectious DiseaseAdvanced HIV opportunistic infection prophylaxisABIM Board

A 41-year-old man with newly diagnosed HIV has CD4 count 48 cells/mm3 and HIV RNA 260000 copies/mL. He has no fever, cough, headache, or focal symptoms. Toxoplasma IgG is positive and G6PD is normal. Which of the following would you recommend?

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Correct answer: A — Begin antiretroviral therapy and start trimethoprim-sulfamethoxazole prophylaxis

CD4 below 100 with positive Toxoplasma IgG warrants TMP-SMX prophylaxis, which also prevents Pneumocystis. ART should be started promptly after evaluation for opportunistic infections; routine MAC prophylaxis is not needed if effective ART is begun immediately.

Reference: DHHS HIV Opportunistic Infection Guidelines