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Self-Assessment Questions

Pulmonary Disease

Answer 2
  1. TMP/SMX and azithromycin. Immunosuppression that results from HIV infection significantly increases the risk for acquiring opportunistic bacterial, viral, fungal, and protozoan infections. These opportunistic infections are a major cause of morbidity and mortality in the HIV population. For this patient with a CD4+ cell count of 10 cells/µL, prophylaxis should have included TMP/SMX and azithromycin for prevention of PCP, toxoplasmosis, and M. avium complex (Table).3 Fluconazole is effective for preventing cryptococcal infection in patients with a CD4+ cell count less than 50 cells/µL, but it is not routinely recommended. Additionally, fluconazole is only recommended for the prevention of Candida infection if the patient has had frequent or severe recurrences.

    3. Kaplan JE, Masur H, Holmes KK. Guidelines for the prevention of opportunistic infections among HIV-infected persons—2002. Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America. Available at http://aidsinfo.nih.gov/contentfiles/OIpreventionGL.pdf. Accessed 5 May 2008.

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