Generic Name Brand Name Generic

Form Dosage Forms Food Restrictions

Opportunistic
Infections (OIs)
Acyclovir Zovirax® 200 mg cap, 400, 800 mg tab

Amphotericin B deoxycholate Fungizone® Injection (50 mg) vial

Amphotericin B lipid complex Abelcet Injection (100 mg/20 mL) vial

in HIV/AIDS
® Give
azithromycin
Amphotericin B liposomal Ambisome® Injection (50 mg) vial 1 hr before
or 2 hrs
Anidulafungin Eraxis®
Injection (50, 100 mg) vial after giving
aluminum/
March 2012
Atovaquone Mepron ®
750 mg/5mL oral susp (5 mL packet, 210 mL bottle) magnesium- Editors: Jeffrey Beal, MD, AAHIVS
containing
antacids Jose A. Montero, MD, FACP
Azithromycin Zithromax® 250, 500, 600 mg tab
Joanne J. Orrick, PharmD, AAHIVE
See
Caspofungin Cancidas ®
Injection (50, 70 mg) vial Managing Editor: Kim Molnar, MAcc
package
insert for Layout: Maximo Lora, BA
Cidofovir Vistide® Injection (75 mg/mL; 5 mL) vial formulations Ashley Vandonkelaar, BFA
and Funded in part by DHHS-HAB Grant No. H4AHA00049
Clarithromycin Biaxin® 250, 500 mg tab, 500 mg ER tab ER instructions
“Guidelines” refers to information adapted from Guidelines for Prevention and Treatment
Clindamycin Cleocin® 150, 300 mg cap of Opportunistic Infections in HIV-Infected Adults and Adolescents. April 10th, 2009.
MMWR 2009; 58 (RR-4) pp 1-198. www.aidsinfo.nih.gov/contentfiles/Adult_OI_041009.pdf.
Clotrimazole Mycelex® 10 mg troche See Guidelines for Rating scheme/level of evidence definitions.
www.aidsinfo.nih.gov/contentfiles/Adult_OI_041009.pdf#page=5.
Do not
Dapsone 25, 100 mg tab admin Preferred OI Primary Prophylaxis
dapsone with
Ethambutol Myambutol® 100, 400 mg tab NOTE: See inside of card for alternative OI prophylaxis regimens
antacids or
alkaline
Famciclovir Famvir® 125, 250, 500 mg tab food/drugs
Indication Infection Preferred Regimen
Fluconazole Diflucan ®
50, 100, 150, 200 mg tab CD4 < 200 (AI)
TMP/SMX -
or
1 DS po once daily (AI)
Flucytosine Ancobon ®
250, 500 mg cap Acid reducing % CD4 < 14% Pneumocystis jirovecii
or
agents ↓ or pneumonia (PCP)
Foscarnet Foscavir® Injection (24 mg/mL; 250, 500 mL) vial itraconazole TMP/SMX -
oropharyngeal
absorption. 1 SS po once daily (AI)
candidiasis (All)1
Ganciclovir Cytovene® Injection (500 mg) vial Admin antacids
≥ 1 hr before CD4 < 100 and
Ganciclovir intraocular implant Vitrasert ®
4.5 mg or 2 hrs after Toxoplasma gondii TMP/SMX -
toxoplasma IgG +
itraconazole. encephalitis 1 DS po once daily (AII)
100 mg cap, 100 mg/10 mL oral soln, Admin
(All)2
Itraconazole Sporanox® caps with cola
10 mg/mL injection azithromycin -
beverage if
1200 mg po every wk (AI)
Leucovorin calcium (Folinic acid) 5, 10, 25 mg tab used with other
acid reducing CD4 < 50 - or
Disseminated
Micafungin Mycamine® Injection (50, 100 mg) vial agents. after ruling out clarithromycin -
Mycobacterium avium
active MAC 500 mg po bid (AI)
complex (MAC) disease
Nitazoxanide Alinia® 500 mg tab, 100 mg/5 mL oral susp infection (Al)3 or
azithromycin -
Nystatin Mycostatin ®
100,000 units/mL oral susp 600 mg po 2x/wk (BIII)
Penicillin G Benzathine Bicillin-L-A® Injection (600,000 units/mL; 1, 2, 4 mL) 1. Additional indications: hx of AIDS-defining illness (BII), CD4 201-249 if CD4
monitoring q1-3 mos is not possible (BII)
Pentamidine NubuPent , Pentam-300
® ®
Inhalation (300 mg) vial, Injection (300 mg) vial
2. Retest Toxo IgG status if CD4 declines to < 100 and pt is receiving PCP
Posaconaozle Noxafil® 200 mg/5 mL oral susp Take prophylaxis not active versus toxoplasmosis (CIII)
posaconaozle 3. Disseminated MAC ruled out by clinical assessment (±) blood culture
Primaquine 26.3 mg tab with a full meal
(high fat
Probenicid 500 mg tab preferred) The information contained in this publication is intended
or nutrional for medical professionals. If a serious adverse event occurs
Pyrimethamine Daraprim® 25 mg tab supplement please report the event to the FDA (www.fda.gov/Safety/
Rifabutin Mycobutin® 150 mg cap
MedWatch/HowToReport/default.htm), to help increase pt
safety. Recognizing the rapid changes that occur in this field,
Sulfadiazine 500 mg clinicians are encouraged to consult with their local experts
TMP/SMX component: 160 mg/800 mg (DS tab),
or research the literature for the most up-to-date information
Trimethoprim/sulfamethoxazole
Septra®, Bactrim® 80 mg/400 mg (SS tab), 80 mg/400 mg per to assist with individual tx decisions for their pt.
(TMP/SMX)
5 mL oral susp, Injection (16 mg/80 mg per mL)
To Request Online Clinical Consultation
Valacyclovir Valtrex® 500, 1000 mg cap
Take
Visit the Florida/Caribbean AETC consultation web page at:
Valganciclovir Valcyte® 450 mg tab
voriconazole
tabs or
www.FCAETC.org/OC
Voriconazole Vfend® 50, 200 mg tab susp ≥ 1 Serving clinicians in Florida, Puerto Rico,
hr before or
= Liquid available = Injection available = Take with food = Take without food after meals and the U.S. Virgin Islands.

Alternative Primary Prophylaxis Candidiasis (Continued) Cryptococcal meningitis (Continued)

Fluconazole-Refractory Oro/Esophageal Candidiasis: Cryptococcal Meningitis
PCP (Alternatives): Preferred, duration based on tx response: Induction/Consolidation Therapy: (Continued)
• TMP/SMX 1 DS po 3x/wk (BI) • Itraconazole oral soln ≥ 200 mg po once daily (AII) or Alternative:
• Dapsone 100 mg po once daily or 50 mg po bid (BI) • Posaconazole 400 mg po bid (AII) • AmBd, liposomal AmB8, or ABLC (dose as preferred tx) alone for
• Dapsone 50 mg po once daily + (pyrimethamine 50 mg + Alternative, duration based on tx response: ≥ 4-6 wks (AII)
leucovorin 25 mg) po every wk (BI) • Amphotericin B deoxycholate 0.3-0.7 mg/kg IV once daily (BII)5 or • (AmBd 0.7 to 1 mg/kg IV once daily + fluconazole 800 mg once daily)
• Aerosolized pentamidine 300 mg monthly via Respigard IITM • Lipid formulation of amphotericin B 3-5 mg/kg IV once daily (BII) or for 2 wks followed by fluconazole 800 mg once daily for ≥ 8 wks (BI)
nebulizer (BI) • Anidulafungin 100 mg IV x 1 dose, then 50 mg IV once daily (BII) or • Fluconazole ≥ 800 mg (1200 mg preferred) per day po plus
• Atovaquone 1500 mg po once daily (BI) • Caspofungin 50 mg IV once daily (CII) or flucytosine (dose as preferred tx) for ≥ 6 wks (BII)
• (Atovaquone 1500 mg + pyrimethamine 25 mg + • Micafungin 150 mg IV once daily (CII) or • Fluconazole 800-2000 mg (≥ 1200 mg per day preferred) per day
leucovorin 10 mg) po once daily (CIII) • Voriconazole 200 mg po or IV bid (CIII) or po for ≥ 10-12 wks (BII)
• Amphotericin B oral susp 100 mg/mL - 1 mL po 4x/day (CIII), not • Itraconazole 200 mg po bid for ≥ 10-12 wks (CII). Use of this option is
Toxoplasmosis (Alternatives): available in US, can be compounded by some pharmacies discouraged and interactions with ART need to be considered.
• TMP/SMX 1 DS po 3x/wk (BIII) ▫▫ Do not use for esophageal candidiasis 8. Liposomal AmB may be given in doses up to 6 mg/kg IV once daily in cases of tx
• TMP/SMX 1 SS po once daily (BIII) 5. Chambers HF, Eliopoulos GM, Gilbert DN, Moellering RC, Saag MS. Sanford failure or high fungal burden
• Dapsone 50 mg po once daily + (pyrimethamine 50 mg + Guide to Antimicrobial Therapy, 2009. 39th ed. Sperryville, VA: Antimicrobial
leucovorin 25 mg) po every wk (BI) Therapy; 2009. NOTE: For those not already on ART, start ART 2-10 wks after
• (Dapsone 200 mg + pyrimethamine 75 mg + initiation of antifungal tx
leucovorin 25 mg) po every wk (BI) Secondary Prevention: Treatment Monitoring:
• Atovaquone 1500 mg ± (pyrimethamine 25 mg + • Prophylaxis not routinely indicated. If recurrences are frequent or
leucovorin 10 mg) po once daily (CIII) • At diagnosis, all pts need cerebrospinal fluid (CSF) opening
severe, consider suppressive tx6
intracranial pressure (ICP) measured (if focal neurologic deficits or
• Pts with fluconazole-refractory oro/esophageal who responded to
Disseminated MAC (Alternatives): echinocandins, voriconazole or posaconazole, should continue tx
impaired mental status, await results of CT scan or MRI before
• Rifabutin 300 mg po once daily (BI) Note: Interacts with many doing LP) (BII)
until ART results in immune reconstitution (CI)
ARVs, dosage adjustments may be required4 ▫▫ If opening pressure ≥ 25 cm H2O and pt has symptoms of
6. See www.aidsinfo.nih.gov/contentfiles/Adult_OI_041009.pdf#page=157. ↑ ICP, LP to reduce ICP by 50% or to < 20 cm H2O (usually
4. See Tables 14 and 15 in the DHHS Adult/Adolescent Treatment Guidelines 20-30 mL CSF removed) (BII)
(updated October 14, 2011) for updated rifamycin/ART drug interaction information. Uncomplicated Vulvovaginal Candidiasis: ▫▫ If ICP persistently ≥ 25 cm H2O, daily LP until symptoms
www.aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf#page=141 Preferred: and ICP stable for > 2 days; consider lumbar drain or
• Fluconazole 150 mg po x 1 dose (AII) or ventriculostomy if daily LP required (BIII)
• Topical azole (clotrimazole, butoconazole, miconazole, tioconazole, ▫▫ Consider permanent CSF shunt only if other measures to
Discontinuation of Primary Prophylaxis: or terconazole) x 3-7 days (AII) control ICP have failed (BIII)
• PCP: CD4 > 200 for > 3 mos in response to ART (AI), • If severe or recurrent give fluconazole 150 mg every q72h x 2-3 ▫▫ Mannitol (AIII), acetazolamide (AII) are not recommended
reinitiate if CD4 falls to < 200 (AIII) doses or use topical azole for ≥ 7 days (AII) ▫▫ Corticosteroids (AII) not recommended unless needed to
• Toxoplasmosis: CD4 > 200 for > 3 mos in response to ART Alternative: manage IRIS
(AI), reinitiate if CD4 falls to < 100-200 (AIII) • Itraconazole oral soln 200 mg po once daily x 3-7 days (BII) • After first 2 wks of tx, repeat LP (only if recurrent signs & symptoms)
• MAC: CD4 > 100 for ≥ 3 mos in response to ART (AI), to evaluate CSF clearance of organism and opening pressure.
reinitiate if CD4 falls to < 50 (AIII)
Cryptococcal meningitis7 (+) CSF at this point predicts relapse and poorer outcome.
Cryptococcal Meningitis ▫▫ Extend induction tx for additional 1-6 wks if pt has any of
Treatment of OIs and Chronic Maintenance following conditions:
Induction/Consolidation Therapy: ∙∙ Comatose or clinically deteriorating
Therapy/Secondary Prevention Preferred: ∙∙ Persistently ↑, symptomatic ICP
Candidiasis • [Amphotericin B deoxycholate (AmBd) 0.7 to 1 mg/kg IV once daily ∙∙ Results of CSF culture anticipated to be positive
+ flucytosine 25 mg/kg/dose po given 4x/day] x 2 wks followed by ∙∙ Induction tx stopped and 2 wk CSF culture is positive,
Oropharyngeal Candidiasis: fluconazole 400 mg po once daily x 8 wks (AI) restart induction tx for additional 2 wks
Preferred, 7-14 day tx: ▫▫ 500 mL normal saline preinfusion may ↓ nephrotoxicity risk ▫▫ If culture positive at relapse, check susceptibilities to see if
• Fluconazole 100 mg po once daily (AI) or ▫▫ Pretreatment with acetaminophen and diphenhydramine may change in tx needed
• Clotrimazole troches 10 mg dissolved po 5x/day (BII) or ↓ infusion-related adverse events • Immune Reconstitution Inflammatory Syndrome (IRIS)
• Nystatin oral susp 4-6 mL swish and swallow 4x/day (BII) or ▫▫ In pts who develop renal dysfunction on tx or who have ↑ risk of ▫▫ Do not alter antifungal tx
• Nystatin 1-2 flavored pastilles 4-5 x/day (BII) or renal dysfunction, [liposomal AmB (Ambisome®)] ▫▫ If signs of CNS inflammation with ↑ ICP consider coritcosteroids
• Miconazole mucoadhesive tab po once daily (BII) 3-4 mg/kg IV once daily or AmB lipid complex (ALBC, Abelect®) (0.5-1 mg/kg per day of prednisone equivalent or higher doses
Alternative, 7-14 day tx: 5 mg/kg IV once daily) + flucytosine (dose ↓ flucytosine if CrCl if needed) for 2-6 wks with careful monitoring of pt (BIII)
• Itraconazole oral soln 200 mg po once daily (BI) or < 40 mL/min) as above for ≥ 2 wks (BII) ▫▫ Not enough data to make a recommendation regarding role for
• Posaconazole oral susp 400 mg po bid x 1 day, then 400 mg po 7. Clinical Practice Guidelines for the Management of Cryptococcal Disease: nonsteroidal anti-inflammatory drugs or thalidomide (CIII)
once daily (BI) 2010 Update by the Infections Diseases Society of America. Clinical Infectious
Diseases 2010; 50: 291-322 Available online at: http://www.idsociety.org/ To order additional copies or request an alternate format of this card: 866-352-2382
Esophageal Candidiasis: uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Cryptococcal.pdf.
The up-to-date PDF is available online: www.FCAETC.org/Treatment
Preferred, 14-21 day tx: NOTE: See the Cryptococcal guidelines referenced above for
• Fluconazole 100-400 mg po or IV once daily (AI) or tx of nonmeningeal, disseminated cryptococcal infection and/or ALSO AVAILABLE FOR ORDER AND DOWNLOAD:
• Itraconazole oral soln 200 mg po once daily (AI) management of asympomatic antigenemia
ARV Therapy in Adults & Adolescents
Alternative, 14-21 day tx: ARV Therapy in Pediatrics
Hepatitis C in HIV/AIDS
• Voriconazole 200 mg po or IV bid (BI) or Oral Manifestations Associated with HIV/AIDS
• Posaconazole 400 mg po bid (BI) or www.facebook.com/FCAETC Post-Exposure Prophylaxis (PEP) & Pre-Exposure Prophylaxis (PrEP)
• Caspofungin 50 mg IV once daily (BI) or Post-Exposure Prophylaxis (PEP) in Pediatrics/Adolescents
• Micafungin 150 mg IV once daily (BI) or www.twitter.com/FCAETC Treatment of STDs in HIV-Infected Patients
Treatment of Tuberculosis (TB) in HIV/AIDS
• Anidulafungin 100 mg IV x 1 dose, then 50 mg IV once daily (BI)
Treatment of OIs and Chronic Maintenance Herpes Zoster (Varicella Zoster Virus, VZV) Syphilis16
(Continued)
Therapy/Secondary Prevention (Continued) 16. See the STD Guidelines:
Herpes Zoster-Extensive www.cdc.gov/std/treatment/2010/STD-Treatment-2010-RR5912.pdf#page=35
Cryptococcal meningitis (Continued) for management of penicillin-allergic pts and alternatives to preferred tx. Penicillin
Cryptococcal Meningitis Cutaneous or Visceral Involvement: is always preferred in managing syphilis in HIV-infected pts.
Maintenance/Suppressive Therapy: • Acyclovir 10-15 mg/kg IV q8h (AII) until pt clinically improving
• Switch to oral tx with acyclovir, famciclovir, or valacyclovir (dosed
Primary, Secondary, Early-Latent (< 1 year):
• Fluconazole 200 mg po once daily (AI) as for acute localized dermatomal) when clinically improving to • Benzathine penicillin G 2.4 million units IM x 1 dose (AII)
• Itraconazole 200 mg po bid, therapeutic drug monitoring complete 10-14 day course (AIII)
recommended, consider interactions with ART (CI) Late-Latent (> 1 year or unknown duration) or Late-
• AmBd 1 mg/kg IV once weekly (consider only in azole intolerant pts Stage (tertiary-cardiovascular or gummatous disease):
as it is less effective and may lead to catheter infections) (CI) Herpes Zoster-Progressive
Outer Retinal Necrosis (PORN): • CSF examination to rule out neurosyphilis
• (Ganciclovir 5 mg/kg + foscarnet 90 mg/kg) IV q12h + • Benzathine penicillin G 2.4 million units IM every wk x 3 doses (AIII)
Discontinuation of twice weekly intravitreal (ganciclvoir 2 mg/0.05 mL or
Maintenance/Suppressive Therapy: foscarnet 1.2 mg/0.05 mL) (AIII) Neurosyphilis (Including otic and ocular):
After ≥ 12 mos of antifungal tx, consider stopping suppressive tx • Optimization of ART is essential (AIII) • Aqueous crystalline penicillin G 18-24 million units per day
in pts virologically controlled on ART with CD4 ≥ 100 for IV divided q4h or via continuous infusion x 10-14 days (AII) ±
≥ 3 mos (BII). Restart if CD4 ↓ to < 100 (BIII). Herpes Zoster-Acute Retinal Necrosis (ARN): benzathine penicillin G 2.4 million units IM every wk x 3 doses after
• Acyclovir 10 mg/kg IV q8h x 10-14 days, then valacyclovir 1 g po completion of IV tx (CIII)
tid x 6 wks (AIII)
Cryptosporidiosis Toxoplasmosis
Preferred:
• Initiate or optimize ART (AII), anti-diarrheal agents as needed as Histoplasma capsulatum infections Acute Treatment:
well as adequate fluid replacement (AIII) (Histoplasmosis) Preferred:
Alternative: • Pyrimethamine 200 mg po x 1 dose then 50 mg (< 60 kg) or 75 mg
• Nitazoxanide 500-1000 mg po bid x 14 days (CIII) + optimized ART,
Disseminated Disease (Moderately severe to severe): (≥ 60 kg) po once daily + sulfadiazine 1000 mg (< 60 kg) or
symptomatic tx, rehydration and electrolyte replacement Preferred: 1500 mg (≥ 60 kg) po q6h + leucovorin 10-25 mg po once daily (AI)
• Induction tx (≥ 2 wks or until clinically improved) with liposomal x ≥ 6 wks depending on response (BII)
amphotericin B 3 mg/kg IV once daily (AI), then maintenance tx Alternative:
Cytomegalovirus Disease (CMV)9 with itraconazole (soln preferred) 200 mg po tid x 3 days, then • Pyrimethamine/leucovorin (dose as in ‘Preferred’, above) +
9. Ganciclovir, valganciclovir and foscarnet require renal dosage adjustments. 200 mg po bid for ≥ 12 mos (AII) clindamycin 600 mg IV or po q6h (AI) or
Caution regarding additive bone marrow toxicity with zidovudine + (ganciclovir Alternative: • TMP/SMX 5 mg/kg of TMP IV or po bid (BI) or
or valganciclovir) • Amphotericin B deoxycholate 0.7 mg/kg IV once daily (BI) or • Atovaquone 1500 mg po bid + pyrimenthamine/leucovorin (dose
CMV Retinitis Acute Treatment: • Amphotericin B lipid complex 5 mg/kg IV once daily (CIII) as in ‘Preferred’, above) (BII) or
• For ≥ 2 wks or until clinically improved, then itraconazole as above • Atovaquone 1500 mg po bid + sulfadiazine 1000 mg (< 60 kg) or
Preferred (Immediate sight-threatening lesions):
• Ganciclovir intraocular implant + valganciclovir 900 mg po bid x 1500 mg (≥ 60 kg) po q6h (BII) or
14-21 days, then once daily (AI) Disseminated Disease (Less severe): • Atovaquone 1500 mg po bid (BII) or
• One dose intravitreal ganciclovir may be given after diagnosis until • Itraconazole as above for ≥ 12 mos (AII) • Pyrimethamine/leucovorin (dose as in ‘Preferred’, above) +
intraocular implant can be placed (CIII) azithromycin 900-1200 mg po once daily (BII)
Preferred (Small peripheral lesions): Meningitis:
• Valganciclovir 900 mg po bid x 14-21 days, then 900 mg po once • Liposomal amphotericin B 5 mg/kg IV once daily for 4-6 wks, then
Chronic Maintenance Therapy:
daily (BII) itraconazole 200 mg po bid-tid for ≥ 12 mos and until resolution of Preferred:
Alternative: CSF abnormalities (AII) • Pyrimethamine 25-50 mg po once daily + sulfadiazine
• Ganciclovir 5 mg/kg IV q12h x 14-21 days then (ganciclovir 5 mg/kg 2000-4000 mg po daily (in 2-4 divided doses) + leucovorin 10-25 mg
IV once daily or valganciclovir 900 mg po once daily) (AI) or Long-Term Suppression: po once daily (AI)
• Foscarnet 60 mg/kg IV q8h or 90 mg/kg IV q12h x 14-21 days, Alternative:
then 90-120 mg/kg IV q24h (AI) or • Itraconazole 200 mg po once daily for pts with severe disseminated • Clindamycin 600 mg po q8h + pyrimethamine 25-50 mg +
• Cidofovir 5 mg/kg IV every wk x 2 wks, then 5 mg/kg IV every other or CNS infection (AII) or in pts who relapse (CIII) leucovorin 10-25 mg po once daily (BI). Should add additional
wk + saline hydration before and after tx + probenecid 2 g po agent to prevent PCP (AII) or
3 hrs before dose followed by 1 g po x 2 doses (2 and 8 hrs after Disseminated Mycobacterium • Atovaquone 750 mg po q6-12h ± [(pyrimethamine 25 mg po once
cidofovir infusion) for total of 4 g. (AI) Note: Avoid in sulfa allergic; daily + leucovorin 10 mg po once daily) or sulfadiazine
cross hypersensitivity with probenecid
avium Complex (MAC) 2000-4000 mg po daily (in 2-4 divided doses)] (BII)
Tx of Acute Infection and for Chronic Maintenance
CMV Retinitis Chronic Maintenance Therapy: Therapy/Secondary Prophylaxis15:
Preferred:
Discontinuation of Secondary Prophylaxis:
Preferred:
• Clarithromycin 500 mg po bid + ethambutol 15 mg/kg po once daily (AI) • Consider if successfully completed tx, asymptomatic, and
• Valganciclovir 900 mg po once daily (AI) or
Alternative: CD4 > 200 for > 6 mos in response to ART (BI)
• Ganciclovir implant (may be replaced q6-8 mos if CD4 remains
• Azithromycin 500-600 mg + ethambutol 15 mg/kg po once daily (AII) • Some recommend MRI for proof of brain lesion resolution before
< 100) + valganciclovir 900 mg po once daily until immune
15. Consider addition of 3rd or 4th agent for CD4 < 50, increased mycobacterial stopping secondary prophylaxis
recovery (BIII)
load, or pt not on effective ART. Caution regarding drug interactions if rifabutin • Restart if CD4 < 200 (AIII)
Alternative:
• Ganciclovir 5 mg/kg IV 5-7 x/wk (AI) or added. See Tables 14 and 15 in the DHHS Adult/Adolescent Treatment Guidelines
(updated October 14, 2011) for updated rifamycin/ART drug interaction information.
• Foscarnet 90-120 mg/kg IV once daily (AI) or
www.aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf#page=141 Special thanks to:
• Cidofovir 5 mg/kg IV every other wk + saline hydration +
Lois Hall, ARNP, MSN
probenecid as above (AI)
of Tampa General Hospital
Discontinuation of Secondary Prophylaxis: for her review and contributions to the 2011 edition
CMV Esophagitis or Colitis:
• Consider if: asymptomatic, ≥ 12 mos of tx completed, and
• Ganciclovir or foscarnet IV x 21-28 days or until resolution of signs CD4 > 100 for ≥ 6 mos in response to ART
and symptoms (dose as for CMV retinitis acute tx) (BII) • Reinitiate secondary prophylaxis (regimen as for acute tx) if
• Oral valganciclovir may be considered if symptoms not severe CD4 falls to < 100
enough to interfere with absorption (dose as for CMV retinitis
acute tx) (BII) Treatment Guideline Resources
• Maintenance tx usually not needed unless relapse (BII)
Mycobacterium tuberculosis HIV CareLink Newsletter • HIV Updates
See Treatment of Tuberculosis (TB) in HIV/AIDS, March 2012
CMV Pneumonitis:
• Consider tx if histologic evidence of CMV pneumonitis and lack of
www.fcaetc.org/Treatment Online Training Modules • Preceptorships
response to tx of other pathogens (AIII) F/C AETC - Project ECHO™ • Chart Reviews
• Maintenance tx role not established (CIII) Pneumocystis jirovecii pneumonia (PCP)
Moderate/Severe: Annual Conference • Specialty Conferences
CMV Neurological Disease10: Preferred:
• Dose as for CMV retinitis acute tx • TMP/SMX: 15-20 mg TMP/kg/day IV divided q6h-q8h (AI), switch Perinatal HIV Prevention Program
• Initiate tx promptly with combination of ganciclovir IV + foscarnet IV to to appropriate po dose after clinical improvement
stabilize disease continue until symptomatic improvement (BII) • Duration of tx: 21 days (base on clinical improvement) (AII) Routine HIV Testing Program
• Maintenance tx (with valganciclovir PO + foscarnet IV) should be Alternative:
continued for life unless immune recovery (BII) • Pentamidine 4 mg/kg IV once daily infused over ≥ 60 mins (AI),
10. AIDS 2000, 14:517-524 some experts ↓ dose to 3 mg/kg IV once daily due to toxicities (BI) or F/C AETC - Project ECHO™
NOTE: When CD4 > 100 for 3-6 mos due to ART, consideration can • Primaquine 15-30 mg (base) po once daily + clindamycin 600-900 mg www.FCAETC.org/ECHO
be given to stopping CMV maintenance tx IV q6h-q8h or 300-450 mg po q6h-q8h (AI) (If possible, test for G6PD
deficiency prior to use of primaquine)
Clinical Consultation
Hepatitis B and C Corticosteroids (PaO2< 70 mmHg on room air or www.FCAETC.org/Consultation
Visit: www.FCAETC.org/Hepatitis to download tools for tx and monitoring of alveolar-arteriol O2 gradient > 35 mmHg) (AI):
hepatitis B and/or C HIV co-infected pts
• Prednisone (begun within 72 hrs of anti-PCP tx): Days 1-5: 40 mg po National Clinicians’
bid; days 6-10: 40 mg po once daily; days 11-21: 20 mg po once daily Post-Exposure Prophylaxis Hotline
Herpes Simplex Virus (HSV) • IV methylprednisolone may be given as 75% of prednisone dose
• Benefits of steroids after 72 hrs unknown; most clinicians would use 888-HIV-4911 (448-4911)
HSV Orolabial Lesions, Initial or Recurrent Genital:
• Acyclovir 400 mg po tid (AI) or Mild/Moderate:
• Famciclovir 500 mg po bid (AI) or National HIV Telephone Consultation Service
Preferred:
• Valacyclovir 1 g po bid (AI)
• TMP/SMX: 15-20 mg TMP/kg/day po divided tid (rounded to
800-933-3413
• Duration of tx: 5-10 days orolabial or 5-14 days genital11
nearest DS tablet containing 160 mg of TMP per tablet, 2 DS tabs
11. STD Treatment Guidelines 2010 state 5-10 days for orolabial or genital
po tid for most adults) (AI) National Perinatal HIV
www.cdc.gov/std/treatment/2010/STD-Treatment-2010-RR5912.pdf#page=25
• Duration of tx: 21 days (base on clinical improvement) (AII) Consultation and Referral Service
Alternative:
HSV Suppressive Therapy: • Dapsone 100 mg po once daily + TMP 15 mg/kg/day po divided tid 888-HIV-8765 (448-8765)
For pts with severe or frequent recurrences (AI) (BI) or
• Acyclovir 400 mg po bid12 or • Primaquine 15-30 mg (base) po once daily + clindamycin 300-450 mg Perinatal HIV Prevention Community
• Famciclovir 500 mg po bid or po q6h-q8h (BI) or
• Valacyclovir 500 mg po bid • Atovaquone 750 mg po bid (BI) www.USFCenter.org/Perinatal
12. STD Treatment Guidelines 2010 state acyclovir 400-800 mg bid to tid
www.cdc.gov/std/treatment/2010/STD-Treatment-2010-RR5912.pdf#page=25 Secondary Prophylaxis: Medication Patient
HSV Severe Mucocutaneous:
Preferred: Assistance Programs Information
• TMP/SMX 160 mg/800 mg 1 DS tab po once daily (AI) or
• Acyclovir 5 mg/kg IV q8h (AII) until lesions begin to improve then • TMP/SMX 80 mg/400 mg 1 SS tab po once daily (AI) www.NeedyMeds.org
change to oral tx as above for initial or recurrent Alternative:
• TMP/SMX 160 mg/800 mg 1 DS tab po 3x/wk (BI) or
HSV Encephalitis: • Dapsone 50 mg po bid or 100 mg po once daily (BI) or
• Acyclovir 10 mg/kg IV q8h x 21 days (AII) • Dapsone 50 mg po once daily + (pyrimethamine 50 mg +
leucovorin 25 mg) po every wk (BI) or
• (Dapsone 200 mg + pyrimethamine 75 mg + leucovorin 25 mg) po
Acyclovir-Resistant HSV13: every wk (BI) or
• Foscarnet 80-120 mg/kg/day IV in 2-3 divided doses until clinical • Aerosolized pentamidine 300 mg monthly via Respigard IITM
response (21-28 days or longer) (AI) nebulizer (BI) or
13. See Guidelines for alternative tx • Atovaquone 1500 mg po once daily (BI) or
www.cdc.gov/std/treatment/2010/STD-Treatment-2010-RR5912.pdf#page=26 • (Atovaquone 1500 mg + pyrimethamine 25 mg + leucovorin 10 mg)
Providing state-of-the-art HIV education,
po once daily (CIII) consultation, and resource materials to
Herpes Zoster (Varicella Zoster Virus, VZV)14 health care professionals throughout the region.
Discontinuation of Secondary Prophylaxis:
14. For infections caused by acyclovir-resistant VZV, use foscarnet 90 mg/kg IV q12h
• Consider in pts who have completed initial tx, remain free of For training opportunities in your local area:
Herpes Zoster-Acute Localized Dermatomal: signs and symptoms of disease, and CD4 > 200 for > 3 mos in
•
•
Acyclovir 800 mg po 5x/day (AII) or
Famciclovir 500 mg po tid (AII) or
response to ART (BII)
• If episode of PCP occurred at CD4 > 200 consider continuing
www.FCAETC.org
PCP prophylaxis for life (CIII)
•
•
Valacyclovir 1 g po tid (AII)
Duration of tx: 7-10 days or > if lesions slow to resolve • Restart if CD4 < 200 (AIII)
866-FLC-AETC (866-352-2382)