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Pneumocystis prophylaxis in HIV — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Pneumocystis prophylaxis in HIVUSMLE Step 3

A 57-year-old man with HIV has been adherent to antiretroviral therapy. Viral load is undetectable and CD4 count is 120/microL. He has no sulfa allergy. He is not taking opportunistic infection prophylaxis. Which of the following is the most appropriate at this time?

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Correct answer: D — Start trimethoprim-sulfamethoxazole prophylaxis

Patients with HIV and CD4 count below 200/microL should receive Pneumocystis jirovecii pneumonia prophylaxis, usually trimethoprim-sulfamethoxazole, even if viral load is suppressed.

Reference: DHHS HIV opportunistic infection guidelines