HIV: Opportunistic Infections and Other Disorders

Key points

• The table below shows the infections and other disorders that may be encountered by patients with HIV according to the CD4 count.
• ORIGINAL SOURCE MISSING — NEW EVIDENCE-BASED CONTENT CREATED. The CD4-stratified table referred to above was never captured and does not exist anywhere in this package. The content below was written from current BHIVA opportunistic-infection guidance; it is NOT recovered source text.
• CD4 is a RISK GUIDE, not a diagnostic criterion — an OI can occur outside its usual CD4 band. Broad bands: < 200 Pneumocystis pneumonia, oesophageal candidiasis · < 100 cerebral toxoplasmosis, cryptococcal disease · < 50 CMV retinitis, disseminated MAC, progressive multifocal leukoencephalopathy. TB and bacterial pneumonia occur at ANY CD4 count.
• PCP PRIMARY PROPHYLAXIS (BHIVA, Grade 1A): co-trimoxazole (trimethoprim-sulfamethoxazole) 960 mg OR 480 mg once daily · alternative 960 mg three times a week (Grade 1B) · BHIVA suggests it could be started at CD4 200–250 if ART is delayed or 3-monthly CD4 monitoring is not possible (Grade 2B).
• STOPPING PROPHYLAXIS: primary PCP prophylaxis can be discontinued once ART has raised the CD4 count above 200 for more than 3 months (Grade 1A) · PCP prophylaxis is NOT needed in someone already taking sulfadiazine with pyrimethamine for cerebral toxoplasmosis (Grade 1B) — a common exam trap.
• CRYPTOCOCCAL disease: screen for cryptococcal antigen at CD4 ≤ 100 · secondary prophylaxis may be stopped after 1 year of therapy once CD4 is above 100 with an undetectable viral load for more than 3 months (Grade 2B).
• DISSEMINATED MAC: BHIVA suggests primary prophylaxis is NOT required even at CD4 below 50, with immediate ART recommended instead (Grade 2A, stated in the BHIVA pregnancy-considerations guidance) — note this differs from older teaching that azithromycin prophylaxis is given at CD4 < 50.
• The overarching principle is that ART itself is the most effective prophylaxis. Starting ART during an acute OI risks IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (IRIS) — paradoxical clinical worsening as immunity recovers — so ART timing relative to OI treatment is decided case by case with specialist input.